Acad Emerg Med. 2020 Jul 30. doi: 10.1111/acem.14096. Online ahead of print.
BACKGROUND: There have been reports of pro-coagulant activity in patients with COVID-19. Whether there is an association between pulmonary embolism (PE) and COVID-19 in the emergency department (ED) is unknown. The aim of this study was to assess whether COVID-19 is associated with PE in ED patients that underwent a CTPA?
METHODS: A retrospective study in 26 EDs from 6 countries. ED patients in whom a computed tomographic pulmonary angiogram (CTPA) was performed for suspected PE during a 2-month period covering the pandemic peak. The primary endpoint was the occurrence of a pulmonary embolism on CTPA. COVID-19 was diagnosed in the ED either on CT or RT-PCR. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period.
RESULTS: A total of 3358 patients were included, of whom 105 were excluded because COVID-19 status was unknown, leaving 3253 for analysis. Among them, 974 (30%) were diagnosed with COVID-19. Mean age was 61 years (19) and 52% were women. A pulmonary embolism was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID-19 patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID-19 was not associated with higher risk of PE (adjusted odds ratio 0.98, 95% confidence interval 0.76 to 1.26). There was no association when limited to patients in the pandemic period.
CONCLUSION: In ED patients that underwent CTPA for suspected PE, COVID-19 is not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID-19 in general.