Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute pulmonary embolism (APE) present a diagnostic challenge in the emergency department (ED) setting. We aimed to identify key clinical characteristics and D-dimer thresholds associated with APE in SARS-CoV-2 positive E...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2023-10-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/9s40r7w8 |
| _version_ | 1827386554792804352 |
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| author | Iltifat Husain James C. O’Neill Jacob H. Schoeneck K. Alexander Soltany Hollins Clark Erika Weidman Rice Alex Gross Jonathan Redding David M. Cline |
| author_facet | Iltifat Husain James C. O’Neill Jacob H. Schoeneck K. Alexander Soltany Hollins Clark Erika Weidman Rice Alex Gross Jonathan Redding David M. Cline |
| author_sort | Iltifat Husain |
| collection | DOAJ |
| description | Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute pulmonary embolism (APE) present a diagnostic challenge in the emergency department (ED) setting. We aimed to identify key clinical characteristics and D-dimer thresholds associated with APE in SARS-CoV-2 positive ED patients. Methods: We performed a multicenter, retrospective cohort study for adult patients who were diagnosed with coronavirus 2019 (COVID-19) and had computed tomography pulmonary angiogram (CTPA) performed between March 17, 2020–January 31, 2021. We performed univariate analysis to determine numeric medians, chi-square values for association between clinical characteristic and positive CTPA. Logistic regression was used to determine the odds of a clinical characteristic being associated with a diagnosis of APE. Results: Of 408 patients who underwent CTPA, 29 (7.1%) were ultimately found to have APE. In multivariable analysis, patients with a body mass index greater than 32 (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.0 -19.3), a heart rate greater than 90 beats per minute (bpm) (OR 5.0, 95% CI 1.0-24.9), and a D-dimer greater than 1,500 micrograms per liter (μg/L) (OR 5.6, 95% CI 1.6-20.2) were significantly associated with pulmonary embolism. In our population that received a D-dimer and was SARS-CoV-2 positive, limiting CTPA to patients with a heart rate over 90 or a D-dimer value over 1500 μg/L would reduce testing 27.2% and not miss APE. Conclusion: In patients with acute COVID-19 infections, D-dimer at standard cutoffs was not usable. Limiting CTPA using a combination of heart rate greater than 90 bpm or D-dimer greater than 1,500 μg/L would significantly decrease imaging in this population. |
| first_indexed | 2024-03-08T15:47:03Z |
| format | Article |
| id | doaj.art-ad731bab054c4499a76569311bc9637e |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-03-08T15:47:03Z |
| publishDate | 2023-10-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-ad731bab054c4499a76569311bc9637e2024-01-09T10:34:55ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182023-10-012461043104810.5811/westjem.5861958619Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department PatientsIltifat Husain0James C. O’Neill1Jacob H. Schoeneck2K. Alexander Soltany3Hollins Clark4Erika Weidman Rice5Alex Gross6Jonathan Redding7David M. Cline8Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North CarolinaWake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North CarolinaWake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North CarolinaWake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North CarolinaUniversity of North Carolina Chapel Hill, Department of Radiology, Chapel Hill, North CarolinaWake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North CarolinaWake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North CarolinaWake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North CarolinaWake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North CarolinaIntroduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute pulmonary embolism (APE) present a diagnostic challenge in the emergency department (ED) setting. We aimed to identify key clinical characteristics and D-dimer thresholds associated with APE in SARS-CoV-2 positive ED patients. Methods: We performed a multicenter, retrospective cohort study for adult patients who were diagnosed with coronavirus 2019 (COVID-19) and had computed tomography pulmonary angiogram (CTPA) performed between March 17, 2020–January 31, 2021. We performed univariate analysis to determine numeric medians, chi-square values for association between clinical characteristic and positive CTPA. Logistic regression was used to determine the odds of a clinical characteristic being associated with a diagnosis of APE. Results: Of 408 patients who underwent CTPA, 29 (7.1%) were ultimately found to have APE. In multivariable analysis, patients with a body mass index greater than 32 (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.0 -19.3), a heart rate greater than 90 beats per minute (bpm) (OR 5.0, 95% CI 1.0-24.9), and a D-dimer greater than 1,500 micrograms per liter (μg/L) (OR 5.6, 95% CI 1.6-20.2) were significantly associated with pulmonary embolism. In our population that received a D-dimer and was SARS-CoV-2 positive, limiting CTPA to patients with a heart rate over 90 or a D-dimer value over 1500 μg/L would reduce testing 27.2% and not miss APE. Conclusion: In patients with acute COVID-19 infections, D-dimer at standard cutoffs was not usable. Limiting CTPA using a combination of heart rate greater than 90 bpm or D-dimer greater than 1,500 μg/L would significantly decrease imaging in this population.https://escholarship.org/uc/item/9s40r7w8 |
| spellingShingle | Iltifat Husain James C. O’Neill Jacob H. Schoeneck K. Alexander Soltany Hollins Clark Erika Weidman Rice Alex Gross Jonathan Redding David M. Cline Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients Western Journal of Emergency Medicine |
| title | Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients |
| title_full | Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients |
| title_fullStr | Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients |
| title_full_unstemmed | Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients |
| title_short | Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients |
| title_sort | clinical characteristics of sars cov 2 acute pulmonary embolism and adjusted d dimer for emergency department patients |
| url | https://escholarship.org/uc/item/9s40r7w8 |
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