Prevalence of diagnosed pulmonary embolism in patients with chronic obstructive pulmonary disease exacerbation presenting at the emergency department of a large North American academic hospital center

AbstractBackgroundThe real prevalence of pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease exacerbation (COPDe) remains largely unknown, especially in North America. Our aim was to evaluate the prevalence of PE in patients with COPDe at a large academic Canadian hospital.MethodsThis is a retrospective cohort study of all adult patients with COPDe seen at the emergency department (ED) of The Ottawa Hospital, Ontario, Canada (June 2019-January 2022). The primary outcome was the prevalence of PE during the initial assessment and at 3 months. Secondary outcomes included prevalence of venous thromboembolism and mortality. Subgroup analyses based on the type of COPDe and the post-ED clinical setting were conducted.ResultsOf 1158 patients seen in the ED with COPDe, PE was diagnosed in 13 patients (1.1%; 95%CI 0.6%-1.9%). Five patients (5/1158; 0.4%) had a diagnosis of PE during initial assessment and 8/1141 (0.7%) patients were diagnosed with PE during the 3-month follow-up. The prevalence of PE did not differ based on the type of COPDe (p = 0.27) and was higher in patients admitted to the hospital compared to patients discharged from the ED (1.1% vs 0.0%; p = 0.01). Mortality was clinically but not statistically higher in patients with PE compared to patients without PE (15.4% vs 6.0%; p = 0.19).ConclusionAmong patients with COPDe evaluated in the ED, the prevalence of diagnosed PE was low, but more than 60% of the PE were diagnosed during the 3-month follow-up. Further studies are needed to determine an appropriate diagnostic algorithm in this population.