Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019 A Case-Control, Emergency Medicine-Based Multicenter Study
Por:
Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo-Putze G, Martín A, Martín-Sánchez FJ, García-Lamberetchs EJ, Jacob J, Alquézar-Arbé A, Mòdol JM, López-Díez MP, Guardiola JM, Cardozo C, Lucas Imbernón FJ, Aguirre Tejedo A, García García Á, Ruiz Grinspan M, Llopis Roca F, González Del Castillo J and Spanish Investigators on Emergency Situations Team (SIESTA) Network
Publicada:
1 mar 2021
Ahead of Print:
1 mar 2021
Resumen:
BACKGROUND Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined.
RESEARCH QUESTION: Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP?
STUDY DESIGN AND METHOD: This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes.
RESULTS: We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56 parts per thousand; 95% CI, 0.40% 0 -0.76 parts per thousand). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28 parts per thousand; 95% CI, 0.26 parts per thousand 0 -0.32 parts per thousand; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/ anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups.
INTERPRETATION: SP as a form of COVID-19 presentation at the ED is unusual (< 1 parts per thousand cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.
Filiaciones:
Miró Ò:
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Llorens P:
Emergency Department, Hospital General de Alicante, University Miguel Hernández, Elche, Spain
Jiménez S:
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Piñera P:
Emergency Department, Hospital Reina Sofía, Murcia, Spain
Burillo-Putze G:
Emergency Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain
Martín A:
Emergency Department, Hospital Severo Ochoa, Leganés, Madrid, Spain
Martín-Sánchez FJ:
Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
García-Lamberetchs EJ:
Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
Jacob J:
Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
Alquézar-Arbé A:
Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Mòdol JM:
Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
López-Díez MP:
Emergency Department, Hospital Universitario de Burgos, Madrid, Spain
Guardiola JM:
Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Cardozo C:
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Emergency Department, Hospital Austral, Buenos Aires, Argentina
Lucas Imbernón FJ:
Emergency Department, Hospital General de Albacete, Spain
Aguirre Tejedo A:
Emergency Department, Hospital del Mar, Barcelona, Spain
García García Á:
Hospital Clínico Universitario de Salamanca, Salamanca, Spain
Ruiz Grinspan M:
Emergency Department, Hospital de Henares, Madrid, Spain
Llopis Roca F:
Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
González Del Castillo J:
Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
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