Design: Retrospective analysis of a prospective multicentre registry
Population: 1,731 emergency department patients with pulmonary embolism
Primary outcome: In-hospital death or clinical deterioration
Effect: CPES ≥3: sensitivity 72%, specificity 57%, AUC 0.68; advanced intervention AUC 0.78

An Annals of Emergency Medicine study used a prospective registry from six US academic emergency departments to assess the Composite Pulmonary Embolism Shock (CPES) score in 1,731 patients with pulmonary embolism, against sPESI and the ESC risk classes.

In-hospital death or deterioration occurred in 11.1%. For that outcome, a CPES score of 3 or more had 72% sensitivity and 57% specificity (AUC 0.68), similar to sPESI and ESC. For predicting advanced intervention, such as thrombolysis or catheter therapy, CPES did better (AUC 0.78), with a negative likelihood ratio of 0.20. Central clot was associated with advanced intervention but not with deterioration.

Risk stratification in PE is mostly about finding who can go home and who needs escalation. These data suggest CPES does not beat existing tools for the first question, but may help identify patients likely to need a PE response team.

Keep using sPESI and ESC classification. A low CPES score may help reassure that advanced therapy is unlikely to be needed.

Continue to use sPESI and ESC risk classes to stratify pulmonary embolism in the emergency department
Consider early PE response team input when shock-related markers cluster, as CPES captures
Do not treat central clot location alone as a marker of deterioration risk
Note that all three tools had modest accuracy for deterioration (AUC under 0.7)

Why it matters

No current tool predicts PE deterioration well, and this one does not change that.

The statistics, in plain English

An AUC of 0.68 is modest: the score ranks a patient who deteriorates above one who does not only about two times in three. A negative likelihood ratio of 0.20 means a low score substantially lowers the chance of needing advanced therapy.