Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome.

AIMS: We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization. METHODS AND RESULTS: We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92‰). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population [35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51-9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65-1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97-2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66-4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations. CONCLUSIONS: PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE.

Impact of the COVID-19 pandemic on hospital emergency departments: results of a survey of departments in 2020 - the Spanish ENCOVUR study. / Impacto organizativo de la pandemia COVID-19 de 2020 en los servicios de urgencias hospitalarios españoles: resultados del estudio ENCOVUR.

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.

OBJETIVO: Estimar el impacto del brote pandémico de COVID-19 en diversos aspectos organizativos de los servicios de urgencias hospitalarios (SUH) españoles e investigar si difirió en función de la comunidad autónoma, tamaño del hospital e incidencia local de la pandemia. METODO: Encuesta a los responsables de los 283 SUH españoles de uso público, quienes valoraron el impacto de la pandemia en aspectos organizativos, disponibilidad de recursos, y bajas del personal durante marzo-abril de 2020, diferenciando dicho impacto por quincenas. Los resultados se analizaron en conjunto, por comunidad autónoma, según tamaño del hospital y según incidencia local de la pandemia. RESULTADOS: Se recibieron 246 encuestas (87% de los SUH españoles). La mayoría de SUH reorganizaron el triaje, primera asistencia y observación y habilitó nuevos espacios específicos para pacientes con sospecha de COVID-19. Un 83% aumentó dotación enfermera (sin diferencias entre grupos) y un 59% la dotación de médicos (más frecuente en hospitales grandes y zonas de alta incidencia). El recurso que más escaseó fue el test diagnóstico de SARS-CoV-2 (55% del tiempo insuficiente con cierta o mucha frecuencia), seguido de mascarillas FPP2-FPP3 (38%), batas impermeables (34%) y espacio asistencial (32%). Hubo más del 5% de médicos/enfermería/otro personal de baja el 20%/19%/16% del tiempo. Estos déficits fueron máximos la segunda quincena de marzo, excepto para los test diagnósticos (primera quincena de marzo). Los SUH de grandes centros tuvieron menos escasez de tests diagnósticos, y los de zonas de alta incidencia pandémica más profesionales de baja. Existieron marcadas diferencias en todas estos déficits entre comunidades autónomas, no siempre concordantes con el grado de afectación pandémica en cada comunidad. CONCLUSIONES: La pandemia COVID-19 generó cambios estructurales en los SUH, que sufrieron una escasez considerable en ciertos recursos, con diferencias marcadas entre comunidades autónomas.

Impacto organizativo de la pandemia COVID-19 de 2020 en los servicios de urgencias hospitalarios españoles: resultados del estudio ENCOVUR / Impact of the COVID-19 pandemic on hospital emergency departments: results of a survey of departments in 2020 - the Spanish ENCOVUR study

OBJETIVO: Estimar el impacto del brote pandémico de COVID-19 en diversos aspectos organizativos de los servicios de urgencias hospitalarios (SUH) españoles e investigar si difirió en función de la comunidad autónoma, tamaño del hospital e incidencia local de la pandemia. MÉTODO: Encuesta a los responsables de los 283 SUH españoles de uso público, quienes valoraron el impacto de la pandemia en aspectos organizativos, disponibilidad de recursos, y bajas del personal durante marzo-abril de 2020, diferenciando dicho impacto por quincenas. Los resultados se analizaron en conjunto, por comunidad autónoma, según tamaño del hospital y según incidencia local de la pandemia. RESULTADOS: Se recibieron 246 encuestas (87% de los SUH españoles). La mayoría de SUH reorganizaron el triaje, primera asistencia y observación y habilitó nuevos espacios específicos para pacientes con sospecha de COVID-19. Un 83% aumentó dotación enfermera (sin diferencias entre grupos) y un 59% la dotación de médicos (más frecuente en hospitales grandes y zonas de alta incidencia). El recurso que más escaseó fue el test diagnóstico de SARS-CoV-2 (55% del tiempo insuficiente con cierta o mucha frecuencia), seguido de mascarillas FPP2-FPP3 (38%), batas impermeables (34%) y espacio asistencial (32%). Hubo más del 5% de médicos/enfermería/otro personal de baja el 20%/19%/16% del tiempo. Estos déficits fueron máximos la segunda quincena de marzo, excepto para los test diagnósticos (primera quincena de marzo). Los SUH de grandes centros tuvieron menos escasez de tests diagnósticos, y los de zonas de alta incidencia pandémica más profesionales de baja. Existieron marcadas diferencias en todas estos déficits entre comunidades autónomas, no siempre concordantes con el grado de afectación pandémica en cada comunidad. CONCLUSIONES: La pandemia COVID-19 generó cambios estructurales en los SUH, que sufrieron una escasez considerable en ciertos recursos, con diferencias marcadas entre comunidades autónomas

OBJECTIVE: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSIONS: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected

Prevención de las complicaciones cardiovasculares asociadas a la diabetes mellitus en los servicios de urgencias / Prevention of cardiovascular complications associated with diabetes mellitus: hospital emergency department involvement

Objetivo: Analizar el perfil de riesgo y la prescripción de tratamiento para la prevención de complicaciones cardiovasculares en los pacientes diabéticos que acuden a los servicios de urgencias hospitalarios (SUH). Método: Estudio de series de casos con análisis transversal llevado a cabo en dos SUH españoles. Se incluyeron de forma consecutiva todos los pacientes con antecedentes o diagnóstico final de diabetes mellitus entre 1 de noviembre de 2010 y 30 de junio de 2011. Se analizó su perfil de riesgo cardiovascular y se consideró como variable de resultado principal la prescripción de tratamiento para la prevención de las complicaciones cardiovasculares al alta del SUH de acuerdo a las recomendaciones de la American Diabetes Association de 2012. Resultados: Se incluyeron 298 pacientes diabéticos, 275 (92%) tipo 2. De ellos 269 (90%) presentaban algún otro factor de riesgo cardiovascular, 147 (49%) lesión previa de órgano diana y 41 (14%) lesión nueva de órgano diana. Ciento setenta y dos pacientes (58%) fueron dados de alta desde el SUH. Aunque 215 pacientes (72%) no cumplían previamente alguna y 30 (10%) ninguna de las recomendaciones de prevención, sólo se modificó el tratamiento farmacológico en un rango de un 1,1% a 3,3% de los pacientes y no se recomendó seguimiento posterior en 42 casos (24%). Conclusiones: Aunque los pacientes diabéticos atendidos en los SUH presentan un elevado riesgo cardiovascular, no se aprovecha esta oportunidad para optimizar el tratamiento de la prevención de las complicaciones cardiovasculares ni garantizar un seguimiento adecuado (AU)

Objectives: To analyze the risk profile of patients with diabetes who seek care from hospital emergency departments and emergency department involvement in preventing cardiovascular complications in these patients. Methods: Cross-sectional analysis of case series from 2 Spanish hospital emergency departments. We included all patients with a history or final diagnosis of diabetes mellitus who were treated in the emergency department between November 1, 2010, and June 30, 2011. Each patient's cardiovascular risk profile was analyzed. The main outcome was the appropriate of prescribed treatment to prevent cardiovascular complications according to the 2012 guidelines of the American Diabetes Association on the patient’s discharge from emergency care. Results: A total of 298 patients were included; 275 (92%) had type II diabetes. Ninety percent of the series (269 patients) had at least 1 cardiovascular risk factor and 147 (49%) had prior target organ damage; target organ damage was newly diagnosed in 41 (14%). Fifty-eight percent (172 patients) were discharged home from the emergency department. Although 215 patients (72%) were not adhering to at least 1 previously prescribed preventive treatment and 30 (10%) were not adhering to any prescribed treatment, drug prescriptions were modified only in 1.1% to 3.3% of patients and no follow-up was recommended in 42 cases (24%). Conclusions: Although diabetic patients treated in emergency departments are at high risk for cardiovascular complications, their visit is not used to optimize preventive treatment for these complications or ensure appropriate follow-up (AU)

[Prevention of cardiovascular complications associated with diabetes mellitus: hospital emergency department involvement]. / Prevención de las complicaciones cardiovasculares asociadas a la diabetes mellitus en los servicios de urgencias.

OBJECTIVES: To analyze the risk profile of patients with diabetes who seek care from hospital emergency departments and emergency department involvement in preventing cardiovascular complications in these patients. MATERIAL AND METHODS: Cross-sectional analysis of case series from 2 Spanish hospital emergency departments. We included all patients with a history or final diagnosis of diabetes mellitus who were treated in the emergency department between November 1, 2010, and June 30, 2011. Each patient's cardiovascular risk profile was analyzed. The main outcome was the appropriate of prescribed treatment to prevent cardiovascular complications according to the 2012 guidelines of the American Diabetes Association on the patient's discharge from emergency care. RESULTS: A total of 298 patients were included; 275 (92%) had type II diabetes. Ninety percent of the series (269 patients) had at least 1 cardiovascular risk factor and 147 (49%) had prior target organ damage; target organ damage was newly diagnosed in 41 (14%). Fifty-eight percent (172 patients) were discharged home from the emergency department. Although 215 patients (72%) were not adhering to at least 1 previously prescribed preventive treatment and 30 (10%) were not adhering to any prescribed treatment, drug prescriptions were modified only in 1.1% to 3.3% of patients and no follow-up was recommended in 42 cases (24%). CONCLUSION: Although diabetic patients treated in emergency departments are at high risk for cardiovascular complications, their visit is not used to optimize preventive treatment for these complications or ensure appropriate follow-up.

OBJETIVO: Analizar el perfil de riesgo y la prescripción de tratamiento para la prevención de complicaciones cardiovasculares en los pacientes diabéticos que acuden a los servicios de urgencias hospitalarios (SUH). METODO: Estudio de series de casos con análisis transversal llevado a cabo en dos SUH españoles. Se incluyeron de forma consecutiva todos los pacientes con antecedentes o diagnóstico final de diabetes mellitus entre 1 de noviembre de 2010 y 30 de junio de 2011. Se analizó su perfil de riesgo cardiovascular y se consideró como variable de resultado principal la prescripción de tratamiento para la prevención de las complicaciones cardiovasculares al alta del SUH de acuerdo a las recomendaciones de la American Diabetes Association de 2012. RESULTADOS: Se incluyeron 298 pacientes diabéticos, 275 (92%) tipo 2. De ellos 269 (90%) presentaban algún otro factor de riesgo cardiovascular, 147 (49%) lesión previa de órgano diana y 41 (14%) lesión nueva de órgano diana. Ciento setenta y dos pacientes (58%) fueron dados de alta desde el SUH. Aunque 215 pacientes (72%) no cumplían previamente alguna y 30 (10%) ninguna de las recomendaciones de prevención, sólo se modificó el tratamiento farmacológico en un rango de un 1,1% a 3,3% de los pacientes y no se recomendó seguimiento posterior en 42 casos (24%). CONCLUSIONES: Aunque los pacientes diabéticos atendidos en los SUH presentan un elevado riesgo cardiovascular, no se aprovecha esta oportunidad para optimizar el tratamiento de la prevención de las complicaciones cardiovasculares ni garantizar un seguimiento adecuado.