Use of the National Early Warning Score for predicting deterioration of patients with acute pulmonary embolism: A post-hoc analysis of the YEARS Study

Roisin Bavalia, Milou A. M. Stals, Frits I. Mulder, Ingrid M. Bistervels, Michiel Coppens, Laura M. Faber, Stephan V. Hendriks, Herman M. A. Hofstee, Menno V. Huisman, Tom van der Hulle, Albert T. A. Mairuhu, Marieke J. H. A. Kruip, Saskia Middeldorp, Frederikus A. Klok, Barbara A. Hutten, Frits Holleman

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)


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.
Original languageEnglish
Article numberemermed-2021-211506
Pages (from-to)61-66
Number of pages6
JournalEmergency Medicine Journal
Issue number1
Early online date2022
Publication statusPublished - 7 Nov 2022


  • clinical management
  • critical care
  • death
  • pulmonary embolism

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