TRIAGE Scoring System: Advancing ECG-Based Early Detection of Acute Pulmonary Embolism

Abstract

Background: Acute pulmonary embolism (APE) as a common cardiopulmonary disease is associated with a high mortality rate. Therefore, its rapid and accurate diagnosis remains a medical challenge. The present study aimed at providing a new electrocardiogram (ECG) model for easy and rapid estimation of the probability of APE through ECG findings. Method: This retrospective study was conducted on 319 patients suspected of APE that were admitted to Shahid Chamran and Al-Zahra Hospitals in Isfahan during 2017-2023. Patients' demographic, clinical, and 16 ECG findings were extracted from their medical records. Other standard criteria such as Wells, Geneva, and Daniel were also calculated. Results: In this study, an ECG-predictive model, called TRIAGE score, was proposed comprising three ECG findings including Tachycardia, Right bundle branch block (RBBB) (complete/incomplete), and Inverted T-wave in the right precordial leads (V1-V4) as well as basic patient characteristics such as Age, Gender, and Edema. TRIAGE score at a higher cut-off point >= 3 with sensitivity of 80.77 and specificity of 50.31 and at a higher cut-off point >= 4 with sensitivity of 44.23 and specificity of 86.50 had a significant diagnostic value in predicting APE (P value < 0.001). Moreover, TRIAGE score had significantly higher diagnostic value than other criteria including Wells, Geneva, Daniel, and d-dimer levels (P value < 0.001). Conclusion: The TRIAGE score, which integrates ECG findings (tachycardia, RBBB, and inverted T-waves in leads V1-V4) with patient characteristics (age, gender, edema), shows promising specificity in diagnosing APE. At a cut-off score of >= 4, it demonstrated statistically significant diagnostic performance compared to existing criteria such as Wells, Geneva, Daniel, and d-dimer levels. These findings suggest the TRIAGE score may serve as a useful adjunct in the early assessment of APE, particularly in settings where advanced imaging is not readily available.