Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19-A Prospective Cohort Study.

Area of Science:

• Pulmonary Medicine
• Infectious Diseases
• Diagnostic Imaging

Background:

• Pulmonary embolism (PE) diagnostic strategies lack prospective evaluation in COVID-19 patients.
• COVID-19 is associated with an increased risk of thrombotic events.

Purpose of the Study:

• To prospectively evaluate the safety and efficiency of diagnostic strategies for suspected PE in COVID-19 patients.
• To assess the applicability of the YEARS diagnostic decision rule in this population.

Main Methods:

• Prospective, multicenter outcome study involving 707 patients with suspected COVID-19 and PE.
• Patients were managed using validated diagnostic strategies, including YEARS, Wells rule, and CTPA alone.
• Safety was assessed by the 3-month failure rate, and efficiency by CTPA avoidance.

Main Results:

• Overall PE prevalence was 28%.
• The YEARS strategy allowed CTPA avoidance in 29% of patients, with a low failure rate (1.4%) for PE exclusion.
• Failure rates for venous thromboembolism (VTE) after negative CTPA were 8.8% within YEARS and 3.6% for CTPA-only management.

Conclusions:

• The YEARS diagnostic strategy is applicable to COVID-19 patients with suspected PE.
• CTPA can be safely avoided in a significant proportion of patients using YEARS.
• A non-negligible VTE failure rate highlights the high thrombotic risk in COVID-19 patients, necessitating continued monitoring.