Modified Wells criteria have high sensitivity but low specificity in PE diagnostics. The Wells score does not correlate well with the Quanadli index.

Introduction/Objective. Early warning scoring systems are important for timely identification of the critically ill, but are they a relevant prognostic tool? Our objective was to test if Modified Early Warning Score (MEWS), lactate and base excess (BE) have any prognostic value in high dependency unit (HDU) patients. Methods. This was a prospective observational study that included 364 patients who were treated at respiratory HDU. The values of MEWS, lactate and BE at admission were recorded with patients' age, sex and comorbidities. Negative outcome was defined as death or transfer to Intensive Care Unit (ICU). Independent predictors of negative outcome were identified with the use of multivariable logistic regression. Results. Of 369 patients, 203 (55%) were male. Mean age was 62 ? 16. There were 138 (37. 4%) patients with negative outcome: 27.37% died, while 10.03% patients required ICU transfer. The median length of hospital stay was 13 days [IQR 7-15]. Patients with negative outcome had a significantly higher MEWS (3.68 ? 1.965 vs. 4.57 ? 2.33, p < 0.001), lower BE (-0.139 ? 7.48 vs. -3.751 ? 6.159, p < 0.001), and a higher lactate (2.299 ? 2.350 vs. 3.498 ? 3.578, p < 0.001). MEWS ? 4 (OR 1.90, CI 1.082-3.340, p = 0.026) was the only independent predictor of mortality. Area under the curve for MEWS with regard to in-hospital mortality prediction was 0.633 (95% CI 0.569-0.697). When age was added to MEWS, the AUC was 0.76 (95% CI 0. 707-0.814). Conclusion. Our findings support the prognostic value of MEWS for final outcome of patients admitted to High Dependency Unit.

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Introduction Diagnostic and therapeutic algorithms for pulmonary embolism (PE) have been frequently modified; however, determining clinical probability, which dictates further procedures, has remained the first step. The objective was to illustrate therapeutic dilemma in a patient with intermediate high risk for 30-day mortality. Case outline The patient was a 56-years-old woman who was referred to our institution for suspected PE. According to the Wells score, the patient was deemed as low-probability for venous thromboembolism, and after further stratification she was placed in a group with intermediate high risk for 30-day mortality. PE was confirmed by computerised tomography pulmonary angiography and she initially received heparin. During the further clinical course, she developed hemodynamic instability, and she received thrombolytic therapy, with a positive outcome. The patient also had increased lactate at admissionmarker of tissue hypoperfusion which is not a part of the routine laboratory work-up in PE patients. Conclusion Current guidelines state that patients with intermediate high risk for 30-day mortality should be treated with heparin, and then continuously monitored in order to timely recognize potential hemodynamic instability and consequently apply thrombolytics. In the outlined case, thrombolytic therapy was applied only after the patient developed hemodynamic instability, although previously she had early signs of tissue hypoperfusion.