Pulmonary embolism diagnosis during an emerging pandemic: A comparison of pandemic to pre-pandemic practice

Title: Pulmonary embolism diagnosis during an emerging pandemic: A comparison of pandemic to pre-pandemic practice
Author(s): S Garvey PJ Kerr R Lee RK Morgan ME O’Brien
Institution: Beaumont Hospital
Poster: Click to view poster
Category: COVID-19
Abstract: Venous thromboembolism and pulmonary embolism (PE) are now recognised complications of SARS-CoV-2 infection in hospitalised patients. A high clinical suspicion for PE must be maintained due to poor discriminant utility of d-dimer and Well’s score in COVID-19 disease.
Our objective was to determine if there was a difference in diagnosis of suspected PE during the early phase of the COVID-19 pandemic in our centre compared to usual practice.

A retrospective audit of CTPA orders and results from 13th March–23rd April 2020 was compared to the same time period in 2019. Data in relation to COVID-19 diagnosis, Well’s score, sPESI score, cardiac biomarkers, presence of right-heart-strain by echocardiogram/CT evaluation were gathered.

During the early pandemic phase, 23 % fewer CTPAs were performed compared to 2019 (103 vs 134). There was no significant difference in positive CTPA studies between study periods (19% vs 16%, P=0.49). CTPA positivity rate was significantly higher in COVID positive patients than COVID negative patients (37.5% vs 14%, P=0.017) . The high case positivity rate is consistent with data from international centres with higher incidences of COVID. This may reflect the disease process, which is known to be thrombophilic, or heightened awareness and diagnosis in the critically ill.
In 2020, 95% of patients with PE were cared for by a respiratory physician in Beaumont Hospital, which was increased from a rate of 27% in 2019. Fewer low risk PEs were diagnosed during the 2020 period, but this study was not powered to examine for differences in severity.

In conclusion, we noted a significant reduction in CTPAs performed in 2020 compared to 2019. Factors including reduced ED presentations, reduced surgical caseload, and absent preceding knowledge of thromboembolic complications of COVID-19 may be contribute to this finding. CTPAs ordered in patients with COVID-19 were more likely to have a positive result. There are several potential explanations for this.
One positive impact of the COVID-19 pandemic on our practice in Beaumont Hospital was increased provision of specalist PE care.