Pulmonary Embolism in COVID-19 Patients: Which Diagnostic Algorithm Should We Use?

Area of Science:

• Pulmonary Medicine
• Infectious Diseases
• Radiology

Background:

• Pulmonary embolism (PE) is a common complication in COVID-19 patients.
• Current diagnostic algorithms for PE in COVID-19 patients with acute respiratory failure are not well-defined.
• Uncertainty exists regarding the appropriate imaging modality (CTPA vs. X-ray/HRCT) for diagnosing PE in this population.

Purpose of the Study:

• To assess the proportion of COVID-19 patients with acute respiratory failure who met criteria for computed tomography pulmonary angiography (CTPA) based on existing guidelines.
• To compare clinical characteristics between patients who underwent CTPA and those who received alternative imaging (X-ray/HRCT).
• To identify distinguishing features of COVID-19 patients with confirmed PE versus those with negative CTPA results.

Main Methods:

• Retrospective analysis of 93 COVID-19 patients with acute respiratory failure.
• Evaluation of CTPA indication using revised Geneva and Wells scores, PERC criteria, and YEARS algorithm.
• Comparison of clinical data between imaging groups and between PE-positive and PE-negative CTPA groups.

Main Results:

• A high percentage of patients (78.4% by Geneva/Wells/PERC, 58% by YEARS) had indications for CTPA.
• Only 30.1% of indicated patients underwent CTPA; these patients were not clinically distinct from those receiving X-ray/HRCT.
• PE was diagnosed in 35.7% (10/28) of patients who underwent CTPA, with no significant clinical differences from PE-negative cases.

Conclusions:

• The selection of imaging for suspected PE in COVID-19 patients with acute respiratory failure is inconsistent.
• Computed tomography pulmonary angiography (CTPA) reveals a high prevalence of PE when performed in this cohort.
• Validated tools are urgently needed to guide the appropriate use of CTPA for PE diagnosis in COVID-19 patients.