Associations of the Composite Pulmonary Embolism Shock Score in the Emergency Department With Short-Term Clinical...

To compare the strength of association and classification characteristics of the Composite Pulmonary Embolism Shock (CPES) score with the simplified Pulmonary Embolism Severity Index (sPESI) and European Society of Cardiology (ESC) classifications for short-term clinical outcomes.

We performed a retrospective independent assessment using prospectively collected pulmonary embolism (PE) registry data from 6 academic emergency departments (2016 to 2020). CPES score was calculated when 5 or more of the 6 components were available. Our primary outcome was in-hospital death or clinical deterioration. Secondary outcomes were advanced intervention and 30-day mortality. Associations were assessed with logistic regression; classification characteristics included area under the receiver operating characteristic curve (AUC) and likelihood ratios (LRs).

Among 1,731 patients, the primary outcome occurred in 193 (11.1%), advanced intervention in 123 (7.1%), and 30-day mortality in 124 (7.2%). For the primary outcome, CPES score 3 or higher yielded sensitivity 72% and specificity 57% (AUC 0.68) and demonstrated LRs similar to sPESI and ESC. For advanced intervention, CPES showed stronger separation (AUC 0.78), with positive and negative LRs of 2.07 (1.90 to 2.25) and 0.20 (0.12 to 0.33), respectively. For 30-day mortality, AUCs and LRs were similar across tools. Central thrombus was independently associated with advanced intervention (odds ratio, 3.46 [1.49 to 8.93]) but not with the primary outcome; concomitant deep venous thrombosis was not associated with outcomes.

CPES, sPESI, and ESC showed similar associations and LRs for short-term adverse outcomes. CPES demonstrated stronger separation for advanced intervention use.