Table 1.
Comparison of Characteristics and Short‐term Outcomes of Patients With PE Diagnosed in the ED Between April 1 and May 1, 2019, Compared to the Same Period in 2020
| CTPA Positive for PE in 2019 (n = 34) | CTPA Positive for PE in 2020 (n = 87) | OR | 95% CI | p‐value | |||
|---|---|---|---|---|---|---|---|
| COVID Positive (n = 49) |
COVID Negative (n = 33) |
All Patients in 2020 | |||||
| Demographics | |||||||
| Age (years) | 65.7 ± 16.9 | 58.1 ± 19.2 | 58.0 ± 17.7 | 57.2 ± 18.7 | — | 0.02 | |
| Male | 12/34 (35) | 30/49 (61) | 18/33 (55) | 51/87 (59) | 2.6 | 1.1 to 5.7 | 0.02 |
| Non‐White race | 22/34 (65) | 39/49 (78) | 24/33 (73) | 67/87 (77) | 1.8 | 0.8 to 4.3 | 0.2 |
| Obesity (BMI > 30) | 9/34 (27) | 25/49 (51) | 12/33 (36) | 39/87 (45) | 2.3 | 0.9 to 5.3 | 0.06 |
| Diabetes | 5/34 (15) | 19/49 (39) | 5/33 (15) | 24/87 (28) | 2.2 | 0.8 to 5.7 | 0.2 |
| Asthma or COPD | 15/34 (44) | 7/49 (14) | 7/33 (21) | 18/87 (21) | 0.3 | 0.1 to 0.8 | 0.009 |
| Major surgery within 4 weeks | 1/34 (3) | 1/49 (2) | 2/33 (6) | 3/87 (3) | 1.2 | 0.2 to 16 | 0.9 |
| History of PE/DVT | 11/34 (32) | 10/49 (20) | 4/33 (12) | 17/87 (20) | 0.5 | 0.2 to 1.2 | 0.1 |
| Active smoker | 6/34 (18) | 3/49 (6) | 5/33 (15) | 9/87 (10) | 0.5 | 0.2 to 1.7 | 0.3 |
| Clinical presentation | |||||||
| Chest pain or shortness of breath | 25/34 (73.5) | 37/49 (76) | 27/33 (82) | 69/87 (79) | 1.4 | 0.6‐3.5 | 0.5 |
| Heart rate (beats/min) | 96.8 ± 19.0 | 114 ± 18.5 | 102.3 ± 19.7 | 108.2 ± 19.5 | — | — | 0.004 |
| Oxygen saturation (%)* | 96.5 ± 3.3 | 94.0 ± 9.8 | 95.4 ± 2.8 | 94.8 ± 7.4 | — | — | 0.03 |
| Unilateral leg swelling | 9/34 (26) | 4/49 (8) | 3/33 (9) | 8/87 (9) | 0.3 | 0.1‐0.8 | 0.02 |
| Laboratory values | |||||||
| White blood cell count (×106) | 8.8 ± 4.8 | 10.9 ± 4.0 | 11.2 ± 5.0 | 10.5 ± 4.3 | — | ‐0.8 to 2.8 | 0.5 |
| D‐dimer > 0.5 mg/L | 14/17 (82) | 45/46 (98) | 30/32 (94) | 78/81 (96) | 5.4 | 1.1 to 24 | 0.07 |
| Troponin > 0.03 ng/mL | 12/32 (38) | 18/47 (38) | 13/31 ( 42) | 31/82 (38) | 1.0 | 0.5 to 2.3 | 0.9 |
| COVID positive by RT‐PCR | — | 49/49 (100) | 0/33 (0) | 49/82 (61)† | — | — | — |
| Imaging findings | |||||||
| Proximal PE (main or lobar artery) | 15/34 (44) | 22/49 (45) | 21/33 (64) | 44/87 (50) | 1.3 | 0.6 to 2.8 | 0.5 |
| Imaging findings of COVID‐19 | — | 46/49 (94) | 23/33 (70) | 70/87 (81) | — | — | — |
| COVID positive by RT‐PCR and/or imaging findings of COVID‐19 | — | 72/87 (83) | — | — | — | ||
| Hospital course‡ | |||||||
| Admitted from ED | 31/34 (91) | 46/49 (94) | 27/33 (82) | 73/87 (84) | 0.7 | 0.2 to 2.3 | 0.5 |
| Transferred care to outside hospital | 1/31 (3) | 4/46 (9) | 1/33 (3) | 5/73 (7) | 2.2 | 0.3 to 27 | 0.7 |
| Length of hospital admission (days) | 4.0 (3.0‐7.8) | 5.0 (3.0‐8.5) | 5.6 (2.0‐10.0) | 5.4 (3.0‐9.9) | — | ‐2.3 to 3.6 | 0.7 |
| BiPAP and/or intubation | 6/30 (20) | 15/42 (36) | 6/26 (23) | 21/68 (31) | 1.8 | 0.7 to 5.0 | 0.3 |
| Admission to ICU | 13/30 (43) | 16/42 (38) | 5/26 (19.2) | 21/68 (31) | 0.6 | 0.2 to 1.4 | 0.3 |
| 14‐day readmission | 2/30 (7) | 3/42 (7) | 1/26 (4) | 4/68 (6) | 0.9 | .2 to 4.8 | 1.0 |
| Disposition of hospitalized patients‡ | |||||||
| Returned home | 18/30 (60) | 32/42 (76) | 20/26 (77) | 52/68 (76) | 1.6 | 0.7 to 4.0 | 0.3 |
| Acute or subacute rehabilitation | 4/30 (13) | 3/42 (7) | 3/26 (11) | 6/68 (9) | 0.4 | 0.1 to 1.5 | 0.2 |
| Still hospitalized 14 days after admission | 3/30 (10) | 9/42 (21) | 3/26 (11) | 12/68 (18) | 1.9 | 0.5 to 6.8 | 0.5 |
| Death within 14 days of admission | 5/30 (17) | 4/42 (10) | 1/26 (4) | 5/68 (7) | 0.4 | 0.1 to 1.4 | 0.3 |
Data are reported as mean ± SD, No./total No. (%), or median (IQR). Data for the 2020 cohort are subdivided into RT‐PCR positive and negative for SARS‐CoV‐2 infection. Statistical tests were performed between the 2019 and 2020 groups. Unpaired parametric Student’s t‐test was used for continuous variables with normal distributions, the nonparametric Mann‐Whitney test was used to compare groups with nonnormally distributed data, and chi‐square analysis was used to compare categorical variables between groups.
BiPaP = bilevel positive airway pressure; BMI = body mass index; COPD = chronic obstructive pulmonary disease; COVID‐19 = coronavirus disease; CTPA = computed tomography pulmonary angiography; DVT = deep venous thrombosis; ICU = intensive care unit; PE = pulmonary embolism; RT‐PCT = reverse transcriptase polymerase chain reaction.
Oxygen saturation on room air was recorded for 28 patients in 2019 and 64 patients 2020 with results provided.
Five patients were not tested for SARS‐CoV‐2 infection. Of the 49 patients who tested positive, 43 patients were tested upon presentation to the ED at their index visit, having undergone no prior SARS‐CoV‐2 testing, and no prior hospitalization for COVID or suspected COVID. Notably, six patients who presented to the ED and found to have PE had tested positive between 9 and 18 days prior to presentation with PE.
Hospital course and disposition do not include patients who were discharged from the ED without hospital admission or patients who were transferred to an outside hospital. Overall, there were 30 patients in 2019 and 68 patients in 2020 who were hospitalized without transfer of care elsewhere.