• Òscar Miró, Pere Llorens, Sònia Jiménez, Pascual Piñera, Guillermo Burillo-Putze, Alfonso Martín, Francisco Javier Martín-Sánchez, Eric Jorge García-Lamberetchs, Javier Jacob, Aitor Alquézar-Arbé, Josep Maria Mòdol, María Pilar López-Díez, Josep Maria Guardiola, Carlos Cardozo, Francisco Javier Lucas Imbernón, Alfons Aguirre Tejedo, García GarcíaÁngelÁHospital Clínico Universitario de Salamanca, Salamanca, Spain., Ruiz GrinspanMartínMEmergency Department, Hospital de Henares, Madrid, Spain., Ferran Llopis Roca, Juan González Del Castillo, and Spanish Investigators on Emergency Situations Team (SIESTA) Network.
• Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic address: omiro@clinic.cat.
• Chest. 2021 Mar 1; 159 (3): 1241-1255.

BackgroundRecent 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 QuestionDo 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 MethodsThis 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.ResultsWe identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; 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.InterpretationSP as a form of COVID-19 presentation at the ED is unusual (< 1‰ 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.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

38 keywords...

hide…