Streamlining Patient Management of Suspected COVID‐19 Patients in the Emergency Department: Incorporation of Pulmonary CT Angiography into the Triaging Algorithm

Abstract

Purpose: To evaluate the use of pulmonary computed tomography (CT) angiography during initial admission at an emergency department (ED), to identify COVID‐19 patients with accompanying pulmonary embolism (PE) and its impact on clinical management. Methods: We performed a retrospective analysis of COVID‐19 patients that underwent pulmonary CT angiography at the ED. CT scans were evaluated for the presence and extent of PE and for imaging changes suspicious of COVID‐19. Patients were subdivided into two groups: (1) Group A consisted of patients with proven COVID‐19 based on real‐time polymerase chain reaction (RT‐PCR), and (2) Group B of patients suspected for COVID‐19, comprising patients positive on RT‐PCR and/or COVID‐19‐suspicious CT findings. To assess the differences between patients with and without pulmonary embolism, Fisher’s exact test was used. Results: A total of 308 patients were admitted to the ED for diagnostic work‐up of dyspnea and suspected COVID‐19, and 95 patients underwent pulmonary CT angiography. PE was detected in 13.6% (3/22) of patients in Group A and 20.7% (6/29) in Group B. No significant differences were observed between patients with and without PE concerning hospitalization (Group B: 100% (6/6) vs. 91.3% (21/23)), the necessity of oxygen therapy (Group B: 66% (4/6) vs. 43.5% (10/23)), and death (Group B: 33% (2/6) vs. 4.3% (1/23) p > 0.05, respectively). Conclusions: In 20.7% of COVID‐19 patients, PE was detected upon admission to the ED. Although the incorporation of early pulmonary CT angiography in patients suspicious of COVID‐19 may be beneficial to identify concomitant PE, further studies are necessary to corroborate these findings.