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Use of the National Early Warning Score for predicting deterioration of patients with acute pulmonary embolism: a post-hoc analysis of the YEARS Study
  1. Roisin Bavalia1,
  2. Milou A M Stals2,
  3. Frits I Mulder1,
  4. Ingrid M Bistervels1,3,
  5. Michiel Coppens1,
  6. Laura M Faber4,
  7. Stephan V Hendriks2,5,
  8. Herman M A Hofstee6,
  9. Menno V Huisman2,
  10. Tom van der Hulle2,
  11. Albert T A Mairuhu5,
  12. Marieke J H A Kruip7,
  13. Saskia Middeldorp1,8,
  14. Frederikus A Klok2,
  15. Barbara A Hutten9,
  16. Frits Holleman10
  1. 1Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
  2. 2Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands
  3. 3Internal Medicine, Flevo Hospital, Almere, The Netherlands
  4. 4Internal Medicine, Red Cross Hospital, Beverwijk, The Netherlands
  5. 5Internal Medicine, Haga Hospital, Den Haag, The Netherlands
  6. 6Medicine, Medisch Centrum Haaglanden, Den Haag, The Netherlands
  7. 7Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
  8. 8Internal Medicine & Radboud Institute of Health Sciences, Radboud University Nijmegen Faculty of Medical Sciences, Nijmegen, The Netherlands
  9. 9Epidemiology and Data Science, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
  10. 10Internal Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
  1. Correspondence to Dr Frits Holleman, Internal Medicine, Amsterdam UMC Locatie AMC, Amsterdam 1105 AZ, The Netherlands; f.holleman{at}amsterdamumc.nl

Abstract

Background The Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI) are validated scores for mortality prediction in patients with pulmonary embolism (PE). National Early Warning Score (NEWS) is a general prognostic risk score for multiple clinical settings. We investigated whether the NEWS had a comparable performance with the PESI and sPESI, for predicting intensive care unit (ICU) admission and death in patients with acute PE.

Methods In haemodynamically stable patients with confirmed PE from the YEARS Study (2013–2015), we evaluated the performance of the NEWS, PESI and sPESI for predicting 7-day ICU admission and 30-day mortality. Receiver operating characteristic curves were plotted and the area under the curve (AUC) was calculated.

Results Of 352 patients, 12 (3.4%) were admitted to the ICU and 5 (1.4%) died. The AUC of the NEWS for ICU admission was 0.80 (95% CI 0.66 to 0.94) and 0.92 (95% CI 0.82 to 1.00) for 30-day mortality. At a threshold of 3 points, NEWS yielded a sensitivity and specificity of 92% and 53% for ICU admission and 100% and 52% for 30-day mortality. The AUC of the PESI was 0.64 (95% CI 0.48 to 0.79) for ICU admission and 0.94 (95% CI 0.87 to 1.00) for mortality. At a threshold of 66 points, PESI yielded a sensitivity of 75% and a specificity of 38% for ICU admission. For mortality, these were 100% and 37%, respectively. The performance of the sPESI was similar to that of PESI.

Conclusion In comparison with PESI and sPESI, NEWS adequately predicted 7-day ICU admission as well as 30-day mortality, supporting its potential relevance for clinical practice.

  • pulmonary embolism
  • critical care
  • death
  • clinical management

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • Handling editor Ed Benjamin Graham Barnard

  • Contributors RB contributed towards collection of data, data analysis and drafting the manuscript. MAMS contributed towards collection of data and drafting the manuscript. FIM contributed towards the data analysis and drafting the manuscript. IMB contributed towards the collection of data and drafting the manuscript. MC contributed towards drafting the manuscript. LMF contributed towards collection of data and drafting the manuscript. SVH contributed towards data collection and drafting the manuscript. HMAH contributed towards data collection and drafting the manuscript. MVH contributed towards data collection and drafting the manuscript. TvdH contributed towards data collection. ATAM contributed towards data collection and drafting the manuscript. MJHAK contributed towards data collection and drafting the manuscript. SM contributed towards study concept. FAK contributed towards study concept, data analyses and drafting the manuscript. BAH contributed towards study concept, data analyses and drafting the manuscript. FH contributed towards study concept, data analyses and drafting the manuscript and acts as the guarantor of this study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.