Low detection rate of pulmonary embolism in patients presenting to the emergency department with suspected coronavirus disease 2019 (COVID-19): a single-centre UK study

Birk, Rubinder; Shaw, Dominick; Kennedy, Cheika; Higashi, Yutaro; Patel, Roma; Gupta, Ayushman; Au-Yong, Iain

PURPOSE: Critically ill patients with COVID-19 are at increased risk of thrombosis. There are limited data on PE rates in COVID-19 patients at presentation to the emergency department (ED). In this study we evaluated the detection rates of PE in patients presenting to the ED with suspected and proven COVID-19. METHODS: A single-centre retrospective study was undertaken of 285 consecutive patients undergoing CT pulmonary angiogram (CTPA) in the Emergency Department at Nottingham University Hospitals NHS Trust in the UK between 25th March and 30th April 2020. At our institution, CTPA is performed in all patients undergoing CT for triage. The study group consisted of patients considered COVID-19 positive based on polymerase chain reaction (PCR) results and CTPA findings. The detection rate of PE in COVID-19 patients was compared to patients undergoing CTPA for suspected PE only and for suspected COVID-19 with no COVID CT findings and negative PCR (control group 1); and CTPAs prior to the coronavirus pandemic (control group 2). RESULTS: 1/48 patients in the study group had a PE (2%) compared to 25/215 (12%) in control group 1 and 10/50 (20%) in control group 2. Prevalence of PE in the study group was lower than in control group 1 (p=0.058) and compared to control group 2 (p=0.005). 11 patients undergoing CTPA had negative PCR but positive CT for COVID-19. CONCLUSION: Detection rate of pulmonary embolus is low in patients with COVID-19 undergoing CTPA on a triage pathway.