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{
    "pk": 17352,
    "title": "Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients",
    "subtitle": null,
    "abstract": "Introduction: \nSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute pulmonary embolism (APE) present a diagnostic challenge in the emergency department (ED) setting. We aimed to identify key clinical characteristics and D-dimer thresholds associated with APE in SARS-CoV-2 positive ED patients.\nMethods:\n We performed a multicenter, retrospective cohort study for adult patients who were diagnosed with coronavirus 2019 (COVID-19) and had computed tomography pulmonary angiogram (CTPA) performed between March 17, 2020–January 31, 2021. We performed univariate analysis to determine numeric medians, chi-square values for association between clinical characteristic and positive CTPA. Logistic regression was used to determine the odds of a clinical characteristic being associated with a diagnosis of APE.\nResults: \nOf 408 patients who underwent CTPA, 29 (7.1%) were ultimately found to have APE. In multivariable analysis, patients with a body mass index greater than 32 (odds ratio [OR] 4.4, 95%confidence interval [CI] 1.0 -19.3), a heart rate greater than 90 beats per minute (bpm) (OR 5.0, 95% CI 1.0-24.9), and a D-dimer greater than 1,500 micrograms per liter (μg/L) (OR 5.6, 95% CI 1.6-20.2) were significantly associated with pulmonary embolism. In our population that received a D-dimer and was SARS-CoV-2 positive, limiting CTPA to patients with a heart rate over 90 or a D-dimer value over 1500 μg/L would reduce testing 27.2% and not miss APE.\nConclusion:\n In patients with acute COVID-19 infections, D-dimer at standard cutoffs was not usable.Limiting CTPA using a combination of heart rate greater than 90 bpm or D-dimer greater than 1,500 μg/L would significantly decrease imaging in this population. [West J Emerg Med. 2023;24(4)1–6.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Covid-19, pulmonary embolism, acute pulmonary embolism"
        }
    ],
    "section": "Clinical Practice",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/9s40r7w8",
    "frozenauthors": [
        {
            "first_name": "Iltifat",
            "middle_name": "",
            "last_name": "Husain",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "James",
            "middle_name": "C.",
            "last_name": "O’Neill",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Jacob",
            "middle_name": "H.",
            "last_name": "Schoeneck",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "K. Alexander",
            "middle_name": "",
            "last_name": "Soltany",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Hollins",
            "middle_name": "",
            "last_name": "Clark",
            "name_suffix": "",
            "institution": "University of North Carolina Chapel Hill, Department of Radiology, Chapel Hill, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Erika",
            "middle_name": "Weidman",
            "last_name": "Rice",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Alex",
            "middle_name": "",
            "last_name": "Gross",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Jonathan",
            "middle_name": "",
            "last_name": "Redding",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "David",
            "middle_name": "M.",
            "last_name": "Cline",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        }
    ],
    "date_submitted": "2022-08-25T14:50:26Z",
    "date_accepted": "2022-08-25T14:50:26Z",
    "date_published": "2023-10-25T14:59:28Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/17352/galley/8816/download/"
        }
    ]
}