Evaluation of the Pulmonary Embolism Comprehensive Screening Scoring (PECSS) using multi-center emergency cohorts.

To verify the scientific, robust and generalizable application of Pulmonary Embolism Comprehensive Screening Scoring (PECSS) in the clinical screening of pulmonary embolism among multi-center emergency cohorts. PECSS were previously derived using emergency cohort from Zhongshan Hospital, with screening performances evaluated and compared to Wells score. In this study, suspected pulmonary embolism (PE) patients from 4 major tertiary hospitals in Shanghai were prospectively enrolled from January to June 2024. Screening performances of PECSS and PECSS with D-Dimer were evaluated and compared to traditional Wells Score (WS) methods among these external validation cohorts. Compared to WS, PECSS achieved low mis-diagnosis rates for all PE severity categories among external validation cohorts. When incorporated with D-Dimer, PECSS demonstrated high sensitivity with acceptable range of specificity. The screening performances of PECSS and PECSS + D-Dimer showed high consistency between the derivation and external validation cohorts, as well as across the 4 external validation centers. The newly developed PECSS and PECSS + D-Dimer screening approaches serve as an effective yet practical tool for the clinical screening of acute PE in emergency setting.