The Role of Standard Scoring Systems in Predicting Early Thrombolysis in Patients with Acute Pulmonary Embolism Presenting to the Emergency Department – A Retrospective Cohort Study.

Objectives: To study the utility of the standard scoring systems for Pulmonary Embolism in predicting the need for early thrombolysis in an Acute Care Setting. Materials and Methods: A retrospective observational study to assess the patients with Pulmonary Embolism (PE) presenting to the Emergency Department (ED) of a quaternary care hospital in South India, from April 2022 to April 2024. We noted the clinical profile, risk factors, the 3-level Wells score (WS) for PE, Revised Geneva score (RGS), and simplified Pulmonary Embolism Sensitivity Index (sPESI) for each patient. We studied the role of the scoring systems in precisely identifying high risk groups and their predictive role in assessing the need for thrombolysis in an acute care setting. The ED outcomes of these patients were noted. Results: Of the 93 confirmed PE patients (mean age 46.4 ± 15.3 years; male-to-female ratio 3:1), 16(17.2%) patients received thrombolysis. The WS system misclassified 23(24.7%) of the confirmed PE patients as having a low-risk prediction of PE. The RGS misclassified 2(2.6%) as low-risk for PE while the sPESI misclassified 16(17.2%) as low-risk for mortality. The risk categorization in these three scoring systems did not reliably predict the need for thrombolysis. The overall mortality was 3/93 (3.2%) and was similar in those who underwent thrombolysis and those managed conservatively. Patients who underwent thrombolysis were more likely to have presented with hypotension, tachycardia, abnormal ECG findings, and right ventricular strain on echocardiography. Conclusion: The commonly used scoring systems of PE for risk stratification and outcome prediction, including the WS, RGS and sPESI scores were not found to accurately predict the need for thrombolysis, when used as the sole predictive tools.