Pulmonary embolism severity before and during the COVID-19 pandemic

ObjectivesEarly in the coronavirus 2019 (COVID-19) pandemic a high frequency of pulmonary embolism was identified. This audit aims to assess the frequency and severity of pulmonary embolism in 2020 compared to 2019. MethodsIn this retrospective audit we compared CTPA frequency and pulmonary embolism severity in April and May 2020, compared to 2019 (total 1288 CTPA). Pulmonary embolism severity was assessed with the Modified Miller score and the presence of right heart strain was assessed. Demographic information and 30-day mortality were identified from electronic health records. ResultsIn April 2020 there was a 17% reduction in the number of CTPA performed and an increase in the proportion identifying pulmonary embolism (26%, n=68/265 versus 15%, n=47/320, p<0.001), compared to April 2019. Patients with pulmonary embolism in 2020 had more comorbidities (p=0.026), but similar age and sex compared to 2019. There was no difference in pulmonary embolism severity in 2020 compared to 2019, but there was an increased frequency of right heart strain in May 2020 (29% versus 12%, p=0.029). Amongst 18 patients with COVID-19 and pulmonary embolism there was a larger proportion of men and an increased 30-day mortality (28% versus 6%, p=0.008). ConclusionDuring the COVID-19 pandemic there was a reduction in the number of CTPA scans performed and an increase in the frequency of CTPA scans positive for pulmonary embolism. Patients with both COVID-19 and pulmonary embolism had an increased risk of 30-day mortality compared to those without COVID-19. Advances in knowledgeDuring the COVID-19 pandemic the number of CTPA performed decreased and the proportion of positive CTPA increased. Patients with both pulmonary embolism and COVID-19 had worse outcomes compared to those with pulmonary embolism alone.