Predictive scores for the diagnosis of Pulmonary Embolism in COVID-19: A systematic review

Objectives During the COVID-19 pandemic, several studies described an increased chance of developing pulmonary embolism (PE). Several scores have been used to predict the occurrence of PE. In this systematic review, we aim at summarizing the literature on predicting rules for PE in hospitalized COVID-19 patients (HCPs). Methods PUBMED and EMBASE databases were searched to identify articles (1 January 2020-28 April 2021) presenting data pertaining the use of a prediction rule to assess the risk for PE in adult HCPs. The investigated outcome was the diagnosis of PE. Studies presenting data on the use of a single laboratory assay for PE prediction were excluded. Included studies were appraised for methodological quality using the Newcastle - Ottawa Quality Assessment Scale for Cohort Studies (NOS). Results We obtained a refined pool of 12 studies, for a total of 5 scoring systems (Wells score, Geneva score, CHADS2/CHA2DS2VASc/M-CHA2DS2VASc, CHOD score, Padua Prediction Score), and 4526 patients. Only one score was specifically designed for HCPs. Three and nine included studies were prospective and retrospective cohort studies, respectively. Among the examined scores, CHOD score seems promising in terms of predictive ability. Conclusion New prediction rules, specifically developed and validated for estimating the risk of PE in HCP, differentiating ICU from non-ICU patients, and taking into account anticoagulation prophylaxis, comorbidities and the time from COVID-19 diagnosis are needed.