Although spontaneous pneumothorax as a form of coronavirus disease 2019 (COVID-19) presentation at the emergency department (ED) was unusual, it was more frequently seen in patients with COVID-19 compared to patients without COVID-19, and may be associated with worse outcomes than spontaneous pneumothorax alone or COVID-19 without spontaneous pneumothorax, according to the results of a case-control study published in CHEST.
Investigators retrospectively reviewed patients with COVID-19 who were diagnosed with spontaneous pneumothorax in 61 EDs across Spain (n=40). This group of patients was compared with patients with COVID-19 but without spontaneous pneumothorax (n=400) and patients without COVID-19 but with spontaneous pneumothorax (n=387) in terms of clinical characteristics, risk factors, and outcomes.
Patients with COVID-19 and spontaneous pneumothorax were significantly older than patients without COVID-19 but with spontaneous pneumothorax (median, 66 vs 36 years, respectively; P <.001). The frequency of spontaneous pneumothorax was significantly higher in patients with COVID-19 vs in patients without COVID-19 (0.28%; odds ratio [OR], 1.93; 95% CI, 1.41-2.71). Additionally, the standardized incidence of spontaneous pneumothorax was higher in patients with COVID-19 (34.2 vs 8.2 per 100,000/y; OR, 4.19; 95% CI, 3.64-4.81).
Compared with patients with COVID-19 but without spontaneous pneumothorax, patients with COVID-19 and spontaneous pneumothorax more frequently developed dyspnea and chest pain, low pulsioxymetry, tachypnea, and increased leukocyte count. Dyspnea at arrival to the ED was in patients with COVID-19 was associated with the highest risk of presenting with concomitant spontaneous pneumothorax (OR, 5.90; 95% CI, 2.27-15.4).
In a sensitivity analysis that included only patients with COVID-19, the development of spontaneous pneumothorax was significantly associated with complaints of dyspnea (OR, 11.4; 95% CI, 2.66-48.6), complaints of chest pain (OR, 5.03; 95% CI, 2.24-11.3), increased leucocytes (OR, 3.93; 95% CI, 1.71-9.05), and respiratory rate of more than 20 breaths per minute (OR, 8.52; 95% CI, 3.14-23.1).
Patients with COVID-19 and spontaneous pneumothorax had higher in-hospital mortality compared with patients with COVID-19 and without spontaneous pneumothorax (adjusted OR, 4.07; 95% CI, 1.73-9.59) and compared with patients without COVID-19 but with spontaneous pneumothorax (adjusted OR, 15.7; 95% CI, 5.17-47.7).
Limitations of this study was its retrospective nature as well as the inclusion of only spontaneous pneumothorax cases that were confirmed with chest X-ray or computed tomography.
The investigators concluded that patients with COVID-19 who are “complaining of dyspnea and chest pain, and exhibiting tachycardia, tachypnea and hypoxemia should be assessed to rule out [spontaneous pneumothorax].”
Miró Ò, Llorens P, Jiménez S, et al; on behalf of the Spanish Investigators on Emergency Situations Team (SIESTA) Network. Frequency, risk factors, clinical characteristics and outcomes of spontaneous pneumothorax in patients with Covid-19: a case-control, emergency medicine-based multicenter study. Published online November 20, 2020. CHEST. doi:10.1016/j.chest.2020.11.013