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Pulmonary embolism and COVID-19: a comparative analysis of different diagnostic models performance

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dc.contributor.authorValente Silva, Beatriz
dc.contributor.authorJorge, Cláudia
dc.contributor.authorPlácido, Rui
dc.contributor.authorMendonça, Carlos
dc.contributor.authorUrbano, Maria Luísa
dc.contributor.authorRodrigues, Tiago
dc.contributor.authorBrito, Joana
dc.contributor.authorAlves da Silva, Pedro
dc.contributor.authorRigueira, Joana
dc.contributor.authorPinto, Fausto J.
dc.date.accessioned2021-10-01T14:48:11Z
dc.date.available2021-10-01T14:48:11Z
dc.date.issued2021
dc.description© 2021 Elsevier Inc. All rights reserved.pt_PT
dc.description.abstractObjective: Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. Several diagnostic prediction rules based on pretest probability and D-dimer have been validated in non-COVID patients, but it remains unclear if they can be safely applied in COVID-19 patients. We aimed to compare the diagnostic accuracy of the standard approach based on Wells and Geneva scores combined with a standard D-dimer cut-off of 500 ng/mL with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in COVID-19 patients. Methods: This retrospective study included all COVID-19 patients admitted to the Emergency Department (ED) who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. The diagnostic prediction rules for PE were compared between patients with and without PE. Results: We included 300 patients and PE was confirmed in 15%. No differences were found regarding comorbidities, traditional risk factors for PE and signs and symptoms between patients with and without PE. Wells and Geneva scores showed no predictive value for PE occurrence, whether a standard or an age-adjusted cut-off was considered. YEARS and PEGeD algorithms were associated with increased specificity (19% CTPA reduction) but raising non-diagnosed PE. Despite elevated in all patients, those with PE had higher D-dimer levels. However, incrementing thresholds to select patients for CTPA was also associated with a substantial decrease in sensitivity. Conclusion: None of the diagnostic prediction rules are reliable predictors of PE in COVID-19. Our data favour the use of a D-dimer threshold of 500 ng/mL, considering that higher thresholds increase specificity but limits this strategy as a screening test.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationAm J Emerg Med. 2021 Sep 18;50:526-531pt_PT
dc.identifier.doi10.1016/j.ajem.2021.09.004pt_PT
dc.identifier.eissn1532-8171
dc.identifier.issn0735-6757
dc.identifier.urihttp://hdl.handle.net/10451/49773
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttps://www.sciencedirect.com/journal/the-american-journal-of-emergency-medicinept_PT
dc.subjectComputed tomography pulmonary angiographypt_PT
dc.subjectCoronaviruspt_PT
dc.subjectD-dimerpt_PT
dc.subjectPulmonary embolismpt_PT
dc.subjectSARS-CoV-2 infectionpt_PT
dc.titlePulmonary embolism and COVID-19: a comparative analysis of different diagnostic models performancept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage531pt_PT
oaire.citation.startPage526pt_PT
oaire.citation.titleThe American Journal of Emergency Medicinept_PT
oaire.citation.volume50pt_PT
person.familyNamePlácido
person.familyNameRodrigues
person.familyNameRigueira
person.familyNamePinto
person.givenNameRui
person.givenNameTiago
person.givenNameJoana
person.givenNameFausto J.
person.identifier574390
person.identifier1308889
person.identifier.ciencia-id4F1C-7834-83AE
person.identifier.ciencia-id1A11-7BF5-0D37
person.identifier.ciencia-id5416-E4FA-AC56
person.identifier.ciencia-idC311-AEDD-6DBB
person.identifier.orcid0000-0002-0962-7024
person.identifier.orcid0000-0003-4164-5481
person.identifier.orcid0000-0003-3248-1251
person.identifier.orcid0000-0003-1014-537X
person.identifier.orcid0000-0002-8034-4529
person.identifier.ridG-9363-2015
person.identifier.scopus-author-id18438045300
person.identifier.scopus-author-id7102740158
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
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