News at admission: a simple tool for early risk stratification in pulmonary embolism

Pulmonary thromboembolism (PTE) is one of the pathologies that causes significant morbidity and mortality. Its presentation can vary greatly, that is why risk stratification is important. Several stratification systems have been used, most of them use laboratory test and echocardiogram variables. The objective of our study is to evaluate the usefulness of the National Early Warning Score (NEWS) at admission as a prognostic marker in patients with PTE.

This is a retrospective observational registry of patients with intermediate-high risk PTE admitted to a Cardiac Intensive Care Unit. Patients were divided into 3 groups based on their NEWS score: < 2 points, 3-4 points, and > 5 points. Differences between groups at admission and the occurrence of events during hospitalization were evaluated.

Among the results, we found differences between groups based on sex, with females being more common among the lowest scores. In terms of presentation, there were no differences between groups when assessing the presence of syncope or elevated cardiac enzymes. However, there were significant differences in lactate levels. In our study, no differences were seen in echocardiographic parameters (severe right ventricular dysfunction).

Regarding evolution during hospitalization, there were no differences in length of stay, but patients with a score > 5 required amines more frequently, had a greater need for intubation, and had a higher rate of fibrinolysis, all of which were significant.

As for other variables analyzed, such as the presence of cardiopulmonary arrest, need for ECMO, or death, there were no differences between groups, probably because the number of events was low and there was insufficient statistical power.

NEWS score > 5 is associated with poorer clinical outcomes and a greater need for advanced therapies. As this scale does not require additional tests, it allows for the early identification of patients who may experience greater clinical deterioration.