Abstract
Purpose
To evaluate the trends in utilization and results of computed tomography pulmonary angiography (CTPA study) for detection of acute pulmonary embolism (PE) in the Emergency Department (ED) during different phases of COVID-19 public health emergency.
Methods
We conducted a retrospective review of CTPA studies ordered through our ED in the months of March through May during five consecutive years from 2019 to 2023, designated as pre-pandemic, early, ongoing, recovery, and post-pandemic periods respectively. Collected characteristics included patient age, patient sex, and result of the study.
Results
The utilization of CTPA studies for ED patients increased during the early, ongoing, and recovery periods. CTPA study utilization in the post-pandemic period was not significantly different from the pre-pandemic period (p = 0.08). No significant difference in CTPA study utilization was noted in the other periods when stratified by age group or sex, compared to the pre-pandemic period. The positivity rate of acute PE in ED patients was not significantly different in other periods compared to the pre-pandemic period.
Conclusion
At our institution, the utilization and positivity rates of CTPA studies for the ED patients were not significantly different in the post-pandemic period compared to the pre-pandemic period. While studies spanning a larger timeframe and involving multiple institutions are needed to test the applicability of this observation to a wider patient population beyond our defined post-pandemic period, we conclude that our study provides some confidence to the ordering provider and the radiologist in embracing the end of COVID-19 public health emergency by the WHO and the United States HHS with respect to CTPA studies.
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References
Schulz K, Mao L, Kanne J (2022) Computed tomography pulmonary angiography utilization in the emergency department during the covid-19 pandemic. J Thorac Imaging 37(4):225–230. https://doi.org/10.1097/RTI.0000000000000649
Soffer S, Klang E, Shimon O, Barash Y, Cahan N, Greenspana H, Konen E (2021) Deep learning for pulmonary embolism detection on computed tomography pulmonary angiogram: a systematic review and meta-analysis. Sci Rep 11(1):15814. https://doi.org/10.1038/s41598-021-95249-3
Küçükceran K, Ayranci MK (2022) The effect of a pandemic on computed tomography pulmonary angiography results and utilize in the emergency department. Clin Experimental Health Sci 12(2):280–284. https://doi.org/10.33808/clinexphealthsci.994118
Kaminetzky M, Moore W, Fansiwala K, Babb JS, Kaminetzky D, Horwitz LI, McGuinness G, Knoll A, Ko JP (2020) Pulmonary embolism at ct pulmonary angiography in patients with covid-19. Radiology: Cardiothorac Imaging 2(4):e200308. https://doi.org/10.1148/ryct.2020200308
Gong X, Yuan B, Yuan Y (2022) Incidence and prognostic value of pulmonary embolism in COVID-19: a systematic review and meta-analysis. PLoS ONE 17(3):e0263580. https://doi.org/10.1371/journal.pone.0263580
Burki T (2023) WHO ends the COVID-19 public health emergency. Lancet Respiratory Med 11(7):588. https://doi.org/10.1016/S2213-2600(23)00217-5
Xavier Becerra (2023) Statement on End of the COVID-19 Public Health Emergency. https://www.hhs.gov/about/news/2023/05/11/hhs-secretary-xavier-becerra-statement-on-end-of-the-covid-19-public-health-emergency.html. Accessed November 14, 2023
Martín-Sánchez FJ, Martínez-Sellés M, García M, Moreno JM, Guillén S, Rodríguez-Artalejo F, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, del González J, Martín-Delgado MC, Bouza E (2023) Insights for COVID-19 in 2023. Revista Española De Quimioterapia 36(2):114–124. https://doi.org/10.37201/req/122.2022
The Lancet (2023) The COVID-19 pandemic in 2023: far from over. Lancet 401(10371):79. https://doi.org/10.1016/S0140-6736(23)00050-8
Katella K (2021) Our pandemic year—a covid-19 timeline. Yale Medicine. https://www.yalemedicine.org/news/covid-timeline. Accessed November 15, 2023
Ahmad FB, Cisewski JA, Xu J, Anderson RN (2023) MMWR Morb Mortal Wkly Rep 72:488–492. https://doi.org/10.15585/mmwr.mm7218a3. Provisional Mortality Data — United States, 2022
Suh YJ, Hong H, Ohana M, Bompard F, Revel M-P, Valle C, Gervaise A, Poissy J, Susen S, Hékimian G, Artifoni M, Periard D, Contou D, Delaloye J, Sanchez B, Fang C, Garzillo G, Robbie H, Yoon SH (2021) Pulmonary embolism and deep vein thrombosis in covid-19: a systematic review and meta-analysis. Radiology 298(2):E70–E80. https://doi.org/10.1148/radiol.2020203557
Wang RC, Miglioretti DL, Marlow EC, Kwan ML, Theis MK, Bowles EJA, Greenlee RT, Rahm AK, Stout NK, Weinmann S, Smith-Bindman R (2020) Trends in imaging for suspected pulmonary embolism across us health care systems, 2004 to 2016. JAMA Netw Open 3(11):e2026930. https://doi.org/10.1001/jamanetworkopen.2020.26930
Franco-Moreno AI, Bustamante-Fermosel A, Ruiz-Giardin JM, Muñoz-Rivas N, Torres-Macho J, Brown-Lavalle D (2023) Utilidad De las escalas de predicción diagnósticas de embolia de pulmón en pacientes con infección por SARS-CoV-2: Una revisión sistemática. Revista Clínica Española 223(1):40–49. https://doi.org/10.1016/j.rce.2022.07.004
Kirsch B, Aziz M, Kumar S, Burke M, Webster T, Immadi A, Sam M, Lal A, Estrada-Y-Martin RM, Cherian S, Aisenberg GM (2021) Wells score to predict pulmonary embolism in patients with coronavirus disease 2019. Am J Med 134(5):688–690. https://doi.org/10.1016/j.amjmed.2020.10.044
Lippi G, Bonfanti L, Saccenti C, Cervellin G (2014) Causes of elevated D-dimer in patients admitted to a large urban emergency department. Eur J Intern Med 25(1):45–48. https://doi.org/10.1016/j.ejim.2013.07.012
Jolobe OMP (2019) Similarities between community-acquired pneumonia and pulmonary embolism. Am J Med 132(12):e863. https://doi.org/10.1016/j.amjmed.2019.03.002
Ozen M, Yilmaz A, Cakmak V, Beyoglu R, Oskay A, Seyit M, Senol H (2021) D-Dimer as a potential biomarker for disease severity in COVID-19. Am J Emerg Med 40:55–59. https://doi.org/10.1016/j.ajem.2020.12.023
Zhan H, Chen H, Liu C, Cheng L, Yan S, Li H, Li Y (2021) Diagnostic value of d-dimer in covid-19: a meta-analysis and meta-regression. Clin Appl Thromb Hemost 27:107602962110109. https://doi.org/10.1177/10760296211010976
Freund, Y., Drogrey, M., Miró, Ò., Marra, A., Féral-Pierssens, A., Penaloza, A., Hernandez,B. A. L., Beaune, S., Gorlicki, J., Vaittinada Ayar, P., Truchot, J., Pena, B., Aguirre,A., Fémy, F., Javaud, N., Chauvin, A., Chouihed, T., Montassier, E., Claret, P., …the IMPROVING EMERGENCY CARE FHU Collaborators. (2020). Association between pulmonary embolism and covid‐19 in emergency department patients undergoing computed tomography pulmonary angiogram: The pepcov international retrospective study. Academic Emergency Medicine, 27(9), 811–820. https://doi.org/10.1111/acem.14096
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Mugu, V.K., Carr, B.M., Olson, M.C. et al. CT pulmonary angiography in the emergency department: utilization and positivity rates during various phases of the COVID-19 pandemic. Emerg Radiol (2024). https://doi.org/10.1007/s10140-024-02218-0
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DOI: https://doi.org/10.1007/s10140-024-02218-0