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Semin Thromb Hemost 2023; 49(07): 716-724
DOI: 10.1055/s-0043-1769938
Review Article

National Early Warning Score-2 for Identification of Patients with Intermediate-High-Risk Pulmonary Embolism

Carmen Rodríguez
1   Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
,
Alfonso Muriel
2   Department of Biostatistics, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
,
Luis Carrasco
1   Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
,
Sara González
1   Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
,
Winnifer Briceño
1   Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
,
Diego Durán
1   Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
,
Ana Retegui
1   Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
,
Roger D. Yusen
3   Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
,
Behnood Bikdeli
4   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
5   Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut
6   Cardiovascular Research Foundation, New York, New York
,
David Jiménez
1   Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
7   CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
8   Department of Medicine, Universidad de Alcalá, Madrid, Spain
› Author Affiliations Funding FIS 2008 (PI 08200), SEPAR 2008, NM 2010. B.B. is supported by the IGNITE Award and the Mary Ann Tynan Research Scientist award from the Mary Horrigan Connors Center for Women's Health and Gender Biology, and the Heart and Vascular Junior Faculty Award at Brigham and Women's Hospital, and a Career Development Award from the American Heart Association and Viva physicians (#938814).
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Abstract

Consensus statements have proposed the use of the National Early Warning Score 2 (NEWS2) to identify stable patients with acute pulmonary embolism (PE) and an intermediate-high risk of adverse outcomes. We aimed to externally validate NEWS2 and compare it to another predictive score (Bova). Using NEWS2 (cutoff ≥5 and ≥7) and the Bova score (cutoff >4), we classified patients as intermediate-high risk (vs. non-intermediate-high risk), and we compared the test characteristics of these risk classification tools for a complicated course within 30 days after PE diagnosis. We also assessed the validity of NEWS2 for predicting a complicated course by adding the results of echocardiography and troponin testing to the model. Of the 848 enrolled patients, the NEWS2 score ≥5 classified 471 (55.5%) and the Bova score classified 37 (4.4%) as intermediate-high risk. NEWS2 had a significantly lower specificity for a 30-day complicated course than Bova (45.4 vs. 96.3%, respectively; p < 0.001). Using the higher score threshold (≥7), the NEWS2 classified 99 (11.7%) as intermediate-high risk, and the specificity was 88.9% (difference with Bova, 7.4%; p < 0.001). The proportion of patients with intermediate-high risk PE was 2.4% for the combination of a positive troponin testing and echocardiographic right ventricle dysfunction and a positive NEWS2 (score ≥7), while the specificity was 97.8% (difference with Bova, 1.5%; p = 0.07). Bova outperforms NEWS2 for predicting a complicated course among stable patients with PE. Addition of troponin testing and echocardiography improved the specificity of NEWS2, although it was not superior to Bova.

ClinicalTrials.gov number: NCT02238639.

Keywords

pulmonary embolism - prognosis - survival - scores

Authors' Contributions

Concept and design: C.R., D.J.


Acquisition, analysis, or interpretation of data; statistical analysis: C.R., A.M., L.C., S.G., W.B., D.D., A.R., R.Y., B.B., D.J.


Drafting of the manuscript: C.R., R.Y., B.B., D.J.


Obtained funding: D.J.


Study supervision: D.J.


D.J. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.


Data Sharing Statement

The datasets generated or analyzed during the current study are available from the corresponding author on reasonable request.




Publication History

Article published online:
16 June 2023

© 2023. Thieme. All rights reserved.

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