NEWS in Action: Leveraging Serial Evaluation for Timely Intervention in Pulmonary Embolism Management

Acute pulmonary embolism (PE) poses a significant clinical challenge with important prognostic and health care cost implications,[1] [2] [3] demanding accurate and timely risk stratification to guide appropriate treatment strategies. In patients with PE, the clinical course in the acute phase may range from early stabilisation and disappearance of symptoms on therapeutic anticoagulation to rapid haemodynamic decompensation and collapse. Consequently, early prognostic assessment is a crucial step in PE management,[4] and various diagnostic pathways have been proposed ([Fig. 1]).[5]

Fig. 1 National Early Warning Score in Pulmonary Embolism: Enhancing Early Risk Stratification. NEWS, National Early Warning Score; RV, right ventricle; (s)PESI, (simplified) Pulmonary Embolism Severity Index; PE, pulmonary embolism.

Current guidelines recommend clinical scores, such as the Pulmonary Embolism Severity Index (PESI) or its simplified version (sPESI), along with biomarkers, such as cardiac troponin levels, and imaging of right ventricular size and function to classify patients in distinct risk categories and guide treatment.[6] However, the promising results of (mostly) cohort studies, and the rapidly growing use of novel advanced reperfusion techniques for PE including catheter-directed thrombolysis and mechanical thrombectomy,[7] generates the urgent need to optimise the definition of threatening decompensation and thus the indications for rational use of catheter systems.[8]

The National Early Warning Score (NEWS) is a standardized, simple, user-friendly clinical tool, which can be used to prompt critical care interventions.[9] The score integrates vital parameters, notably level of consciousness, respiratory rate, oxygen saturation, temperature, blood pressure, and heart rate. Its major strengths are its practicality and widespread adoption, by physicians and nurses alike, in routine care in many countries. The utility of NEWS in predicting patient outcomes in various acute illnesses has been successfully validated.[10] However, its prognostic value in the specific clinical setting of acute PE has not been systematically investigated thus far.

The article by Janata and colleagues[11] in the present issue of Thrombosis and Haemostasis sheds valuable light on this critical need, demonstrating the potential of NEWS in predicting early adverse outcomes in patients with acute PE. NEWS outperformed the PESI in predicting 30-day mortality and the need for rescue therapy in PE patients, and its addition to the European Society of Cardiology (ESC) risk classification[6] appeared to further improve the ability to predict acute-phase prognosis. The finding that a NEWS ≥ 7 within the ESC intermediate-high and high-risk groups was associated with much higher 30-day mortality rates (24 vs. 1%) is impressive, although this NEWS cut-off value per se is in accordance with earlier validations of the score in critically ill patients due to other pathologies.[10] Thus, the present study extends the results of Bavalia and colleagues,[12] who had evaluated the performance of NEWS in haemodynamically stable patients with acute confirmed PE and reported that it could successfully predict 7-day intensive care unit admission and 30-day mortality.

Taken together, these data support the potential of NEWS to improve risk stratification and possibly identify patients who may benefit most from timely advanced therapeutic interventions. These interventions comprise not only catheter-directed treatment options currently being evaluated in randomized clinical trials,[1] but also reduced-dose systemic thrombolysis for intermediate–high-risk PE.[13]

Despite the overall promise that NEWS holds as a score, the optimal cut-off value for defining imminent instability in PE patients remains to be determined. The study by Janata and colleagues[11] suggests a NEWS of ≥7 as a potential threshold, but further research is needed to validate this finding and to explore whether different cut-offs might be more appropriate for specific patient subgroups. Studies combining NEWS with imaging parameters, biochemical markers, and other findings indicative of so-called normotensive shock[14] might also help to improve its accuracy and clinical relevance for PE risk stratification.

Acute PE is a dynamic condition that necessitates serial assessments. Regular monitoring of NEWS and its trend over the first hours and days following presentation and treatment initiation could become a key element in identifying patients in whom initial (e.g., anticoagulant) therapy may be failing and treatment escalation is required. Serial NEWS assessments, coupled with trends in biomarkers, notably lactate levels, and imaging parameters capturing the dynamics of right ventricular function, could provide a better overview of a patient's risk trajectory. For example, a patient initially classified as having intermediate–low-risk PE may exhibit a rising NEWS score suggesting imminent hemodynamic compromise or collapse. This would in turn signal the need for advanced therapy. The simplicity of NEWS means that it can seamlessly be integrated into hospital systems and electronic health records, generating timely alerts when a patient's score reaches a predefined threshold. Clearly, this notion also needs to be validated within prospective randomized trials.

Among the first to do so is HI-PEITHO, a multicentre, adaptive-design, parallel-group comparison trial with blinded adjudication of outcomes comparing ultrasound-facilitated catheter-directed fibrinolysis to the current standard of care. HI-PEITHO has incorporated NEWS into its primary endpoint with the aim to evaluate its usefulness in guiding rescue treatment.[15]

In conclusion, the study by Janata and colleagues[11] provides promising insights into the role of NEWS in PE risk stratification. Future research should focus on validating protocols for serial NEWS assessment, defining optimal cut-off criteria, and exploring the role of NEWS in conjunction with laboratory parameters and imaging techniques. By embracing a dynamic and personalized approach, we can optimise treatment strategies and improve outcomes for patients with acute PE.

Publication History

Received: 13 December 2025

Accepted: 15 December 2025

Article published online:
29 December 2025

• References

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