Prevalence of Pulmonary Embolism in Patients with Chronic Obstructive Pulmonary Disease Exacerbation in North America – A Single Center Experience

Background: The real prevalence of pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease exacerbation (COPDe) is still unknown, especially in North America. The aim of this study was to evaluate the prevalence of PE in patients with COPDe at a Canadian center.Methods: This is a retrospective cohort study of adult patients with COPDe seen at the emergency department (ED) of The Ottawa Hospital, Ontario, Canada, from June 2019 to 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 exacerbation and the clinical settings were conducted.Results: Of 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 exacerbation (p=0.27) but 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 not statistically higher in patients with PE compared to patients without PE (15.4% vs 6.0%; p=0.19).Conclusion: Among patients with COPDe evaluated in the ED, the prevalence of 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 specific population.