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neither the change in PE incidence in the general population during the pandemic nor the possible differential characteristics of the PE that occurred during this period have been investigated&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Population and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a retrospective study using the radiology and electronic medical record archives of a university hospital in the Community of Madrid &#40;Spain&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Two time periods were defined&#58; the study period&#44; from March 01 to May 31&#44; 2020&#44; and a control period&#44; which was this same period in 2019&#46; During these periods&#44; all computed tomography pulmonary angiogram &#40;CTPA&#41; requests in which a clinical suspicion of PE was listed were identified&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The tests had been conducted using multidetector computed tomography &#40;CT&#41; &#40;Brilliance&#59; Philips&#44; Eindhoven&#44; the Netherlands&#41; following the standard protocols&#46; All were re-analyzed by two expert radiologists in order to detect intraluminal filling defects in the proximal or distal pulmonary arteries &#40;segmental or subsegmental&#41;&#46; The medical records of patients who were ultimately diagnosed with PE were retrieved and the predisposing clinical conditions included in the revised Geneva score<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> were recorded along with D-dimer&#44; determined by immunoturbidimetry &#40;STA&#174;-Liatest&#174; D-Di Plus&#44; Stago&#44; Asni&#232;res-sur-Seine&#44; France&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">During the study period&#44; the results of a real-time polymerase chain reaction &#40;RT-PCR&#41; for SARS-CoV-2 and time since COVID-19 symptoms onset and suspicion of PE were recorded&#46; The COVID-19 diagnosis was based on World Health Organization &#40;WHO&#41; criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The incidence of COVID-19 in the population served by the hospital was obtained by consulting public records&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test was used for qualitative variables &#40;expressed as proportions&#41;&#46; Means of the quantitative variables were compared using Spearman&#8217;s test &#40;for nonrelated variables&#41;&#44; expressed as mean&#160;&#177;&#160;standard deviation&#46; A value of <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;&#46;05 was considered significant&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The relative risk of PE between both periods was calculated based on the number of PE detected and the population attended to in each period with a 95&#37; confidence interval &#40;CI&#41;&#46; The data were analyzed with the IBM SPSS 22 program &#40;Armonk&#44; NY&#59; USA &#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study was approved by the hospital&#8217;s research ethics committee &#40;OE33&#47;2020&#41;&#44; which exempted it from the need to obtain consent&#44; given the study&#8217;s retrospective nature&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">During the control period&#44; a CTPA was ordered for suspicion of PE for 145 patients&#44; 22 of which &#40;15&#46;2&#37;&#41; were ultimately diagnosed with PE&#46; During the study period&#44; 465 CTPA were ordered for suspicion of PE&#44; 99 of which &#40;21&#46;3&#37;&#41; were confirmed and eight &#40;8&#37;&#41; of which were in patients hospitalized in the ICU&#46; A total of 74 had previously been diagnosed with COVID-19&#44; with a mean period between the diagnoses of 9&#46;1&#160;&#177;&#160;8&#46;4 days&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Of the 1292 patients hospitalized with a diagnosis of COVID-19 in this period&#44; 5&#46;7&#37; &#40;74&#41; were diagnosed with PE&#46; Considering the population served by the hospital&#44; the relative risk of PE during the study period compared to the control period was 4&#46;5 &#40;95&#37; CI 2&#46;80&#8211;6&#46;99&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the incidence curves for PE and COVID-19 estimated for the population served by the hospital&#46; They had a similar trend&#44; but PE occurred after a delay&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the rest of the results&#46; During the study period&#44; patients with PE were more frequently men &#40;69&#46;7&#37; vs&#46; 54&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;NS&#41; and there were no relevant differences in mean age &#40;65&#46;1&#160;&#177;&#160;19&#46;0 vs&#46; 66&#46;6&#160;&#177;&#160;15&#46;0&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;NS&#41;&#46; They had fewer episodes of prior PE &#40;5&#46;1&#37; vs&#46; 18&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;05&#41;&#44; deep vein thrombosis &#40;DVT&#41; &#40;11&#46;1 vs&#46; 45&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;0001&#41;&#44; and surgery in the previous month &#40;2&#37; vs&#46; 35&#46;4&#37;&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">D-dimer levels were higher in cases of PE associated with COVID-19 &#40;11&#46;9&#160;&#177;&#160;27&#46;5 vs&#46; 3&#46;4&#160;&#177;&#160;5&#46;0&#160;mg&#47;L&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;017&#41; and they tended to be higher&#44; though not significantly so&#44; during the study period&#46; PE were more frequently distal during the pandemic period &#40;73&#46;5&#37; vs&#46; 50&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;02&#41; and also in patients with COVID-19 versus those who did not have COVID-19 &#40;83&#46;6&#37; 57&#46;9&#37;&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;005&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Our study shows an increase in the incidence of PE during the first months of the pandemic&#44; with up to 4&#46;5 times greater risk compared to the same period the previous year&#46; It includes PE that were associated and not associated with COVID-19 in hospitalization wards &#40;91 cases&#41; as well as in the ICU &#40;eight cases&#41;&#46; The difference between both periods &#40;77 cases&#41; almost entirely coincides with cases of PE associated with COVID-19 &#40;74 episodes&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Some authors<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> have described a cumulative incidence of PE of 24&#37; in patients with COVID-19 in whom a CTPA is performed&#46; This piece of data leads to confusion&#59; it refers to the proportion of positive studies in patients who had the test performed for some reason and not the prevalence in the entire population hospitalized due to COVID-19&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Some meta-analyses have shown a high incidence of PE&#44; but the majority of cases included come from patients hospitalized in the ICU&#44; who have a greater incidence&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Thus&#44; the clearest information can be found in specific series&#46; In a series of 184 patients with COVID-19 hospitalized in three ICUs&#44; 25 &#40;13&#46;6&#37;&#41; had a PE&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> a similar figure &#40;16&#46;7&#37;&#41; to what was reported in a prospective analysis of 150 consecutive patients admitted in four other ICUs&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">On the other end&#44; a series of patients hospitalized in the internal medicine ward of a hospital had a PE incidence of 6&#46;2&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> similar to our finding of 5&#46;7&#37;&#46; Therefore&#44; around 6&#37; of patients hospitalized due to COVID-19 may have a PE&#44; with figures increasing to 13&#37;&#8211;17&#37; in critical cases in the ICU&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We have observed a delay between COVID-19 diagnosis and suspicion of PE&#44; which is clearly perceptible in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; In light of the foregoing&#44; we must be alert to signs of deterioration in COVID-19 patients after the first week of hospitalization&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">PE found during the pandemic period differed from those diagnosed in the previous year&#46; Patients had fewer predisposing conditions for having one and obstruction was more often distal&#46; The same was true when comparing patients with PE with and without COVID-19&#46; COVID-19 appears to be associated in and of itself with a greater risk of developing PE&#44; probably greater than what is described in other types of lung pneumonia&#44; in which distal PE is also more common&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Other authors have also found an increase in distal PE in patients with COVID-19<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and this could be at least in part due to the association of COVID-19 with in situ pulmonary thrombosis&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> An increase in other types of PE during the pandemic is in part to be expected&#44; given that lockdown could be a cause of immobility and there has been a dramatic increase in the number of critically ill patients with greater risk of PE&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">The retrospective nature of this study does not allow for standardization of suspicion of PE&#46; A risk stratification was not conducted for the PE observed due to the small size of the sample&#46; DVT may not have been systematically investigated during the peak of the pandemic due to logistical reasons&#46; The majority of samples for RT-PCR were obtained using nasopharyngeal swabs&#44; a technique with an estimated sensitivity of 63&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Therefore&#44; some of the 25 cases of PE without a COVID-19 diagnosis could have been infected&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Estimated incidence of PE for the population is just an approximation&#44; there were many possible causes for a loss of cases that could cause an underestimation&#44; including patients who died in nursing homes and terminal cases which were not investigated&#46; In any case&#44; the real incidence of PE during the pandemic would be higher&#44; not lower&#44; than during the control period and would lend support to the initial hypothesis&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">It is also plausible that CT scans were underused due to the emergency situation&#46; Nevertheless&#44; a CTPA was ordered due to suspicion of PE in a third of patients hospitalized due to COVID-19 during the study period&#44; with a rate of confirmed diagnosis of 21&#46;3&#37;&#44; which was not statistically different from the rate found during the control period&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When used correctly&#44; CTPA should detect PE in 30&#37; of all CTPAs ordered&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Therefore&#44; our data do not suggest underuse in any of the periods and are in agreement with the test&#8217;s diagnostic capacity in other studies conducted on patients with COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic is associated with a greater risk of PE&#46; This risk seems to increase one or two weeks following infection&#46; During the pandemic period&#44; PE affected patients with a different clinical profile who often had COVID-19&#46; In addition&#44; the obstruction of vessels was more frequently distal&#46; Our results support the hypothesis that COVID-19 is a risk factor for having a PE with specific characteristics&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">This research has not received specific grants from agencies in the public&#44; commercial&#44; or non-profit sectors&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2020-11-25"
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          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "COVID-19"
            1 => "Pulmonary embolism"
            2 => "SARS-CoV-2"
            3 => "Coronavirus"
            4 => "Thrombosis"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:5 [
            0 => "COVID-19"
            1 => "Embolismo pulmonar"
            2 => "SARS-CoV-2"
            3 => "Coronavirus"
            4 => "Trombosis"
          ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A high incidence of pulmonary embolism has been described during the coronavirus pandemic&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a single-center retrospective study which reviewed computed tomography pulmonary angiograms ordered due to suspected pulmonary embolism during two periods&#58; from March 1&#44; 2020 to May 31&#44; 2020 &#40;pandemic&#41; and during the same interval in 2019 &#40;control&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Twenty-two pulmonary embolisms were diagnosed during the control period and 99 in the pandemic&#44; 74 of which were associated with COVID-19&#46; Of all patients hospitalized with COVID-19&#44; 5&#46;3&#37; had a pulmonary embolism&#44; with a delay between the two diagnoses of 9&#46;1&#160;&#177;&#160;8&#46;4 days&#46; During the pandemic&#44; patients with pulmonary embolism had fewer predisposing conditions &#40;previous pulmonary embolism 5&#46;1 vs&#46; 18&#46;2&#37;&#44; p&#160;&#61;&#160;&#46;05&#59; previous surgery 2 vs&#46; 35&#46;4&#37;&#44; p&#160;&#61;&#160;&#46;0001&#59; deep vein thrombosis 11&#46;1 vs&#46; 45&#46;5&#37;&#44; p&#160;&#61;&#160;&#46;0001&#41;&#59; peripheral pulmonary embolisms were the most frequent &#40;73&#46;5 vs&#46; 50&#37;&#44; p&#160;&#61;&#160;&#46; 029&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">There is an increased risk of having a pulmonary embolism during the SARS-CoV-2 pandemic&#44; which affects patients with a different clinical profile and more often causes distal pulmonary embolisms&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se ha descrito una elevada incidencia de tromboembolismo pulmonar &#40;TEP&#41; durante la pandemia por coronavirus&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo unic&#233;ntrico&#44; con revisi&#243;n de las angiograf&#237;as pulmonares por tomograf&#237;a computarizada solicitadas por sospecha de tromboembolismo pulmonar durante dos per&#237;odos&#44; del 01 de marzo del 2020 al 31de mayo del 2020 &#40;pandemia&#41;&#44; e igual intervalo en 2019 &#40;control&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se diagnosticaron 22 tromboembolismos pulmonares durante el per&#237;odo control y 99 en el pand&#233;mico&#44; 74 asociados con COVID-19&#46; El 5&#44;3&#37; de los pacientes hospitalizados con COVID-19 sufri&#243; un tromboembolismo pulmonar&#44; con un retraso entre ambos diagn&#243;sticos de 9&#44;1&#160;&#177;&#160;8&#44;4 d&#237;as&#46; Durante la pandemia&#44; los pacientes con tromboembolismo pulmonar ten&#237;an menos condiciones predisponentes &#40;tromboembolismo pulmonar previo 5&#44;1 vs&#46; 18&#44;2&#37;&#44; p&#160;&#61;&#160;0&#44;05&#44; cirug&#237;a previa 2 vs&#46; 35&#44;4&#37;&#44; p&#160;&#61;&#160;0&#44;0001&#44; trombosis venosa profunda 11&#44;1 vs&#46; 45&#44;5&#37;&#44; p&#160;&#61;&#160;0&#44;0001&#41;&#44; y los tromboembolismos pulmonares perif&#233;ricos eran m&#225;s frecuentes &#40;73&#44;5 vs&#46; 50&#37;&#44; p&#160;&#61;&#160;0&#44;029&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Existe un riesgo incrementado de sufrir un TEP durante la pandemia por SARS-CoV-2&#44; que afecta a pacientes con perfil cl&#237;nico diferente y causa m&#225;s frecuentemente TEP distales&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a-Lled&#243; A&#44; del Palacio-Salgado M&#44; &#193;lvarez-Sanz C&#44; P&#233;rez-Gil MM&#44; Cruz-D&#237;az &#193;&#46; Tromboembolismo pulmonar durante la pandemia por SARS-CoV-2&#58; caracter&#237;sticas cl&#237;nicas y radiol&#243;gicas&#46; Rev Clin Esp&#46; 2022&#59;222&#58;354&#8211;358&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Graph of COVID-19 incidence and PE in the reference population during the pandemic&#46; The lines represent the daily sum of cases during the previous 14 days for COVID-19 and for PE cases in the hospital&#8217;s reference population&#46; The scale of PE incidence is ten times lower than that of COVID-19&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PE&#58; pulmonary embolism&#46;</p>"
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        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; LDH&#58; lactate dehydrogenase&#59; bpm&#58; beats per minute&#59; death&#58; in-hospital death&#59; CRP&#58; C-reactive protein&#59; RR&#58; relative risk&#59; RT-PCR&#58; reverse-transcription polymerase chain reaction&#59; Sat O<span class="elsevierStyleInf">2</span>&#58; oxygen saturation&#59; DVT&#58; deep vein thrombosis&#59; ICU&#58; intensive care unit admission&#59; NS&#58; not significant&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Period</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Significance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RR 4&#46;5 &#40;95&#37; CI 2&#46;80&#8722;6&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex &#40;male&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;54&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;69&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;1&#160;&#177;&#160;19&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;6&#160;&#177;&#160;15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COVID-19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous PE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;18&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery in the past month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;35&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Active neoplasm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;27&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DVT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peripheral PE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;73&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart rate &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#160;&#177;&#160;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#160;&#177;&#160;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sat O<span class="elsevierStyleInf">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#160;&#177;&#160;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#160;&#177;&#160;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neutrophils &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7252&#160;&#177;&#160;3000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7666&#160;&#177;&#160;4744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lymphocytes &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2421&#160;&#177;&#160;4100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1337&#160;&#177;&#160;732&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Platelets &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">259&#160;&#177;&#160;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">288&#160;&#177;&#160;295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibrinogen mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">557&#160;&#177;&#160;229&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">438&#160;&#177;&#160;198&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">691&#160;&#177;&#160;629&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ICU&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;9&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical and radiological data of patients with a diagnosis of pulmonary embolism &#40;PE&#41; during the control period &#40;2019&#41; and the pandemic period &#40;2020&#41;&#46;</p>"
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Brief Original
Pulmonary embolism during SARS-CoV-2 pandemic: Clinical and radiological features
Tromboembolismo pulmonar durante la pandemia por SARS-CoV-2: características clínicas y radiológicas
A. García-Lledóa,b,
Corresponding author
, M. del Palacio-Salgadoc, C. Álvarez-Sanzb,c, M.M. Pérez-Gila, Á. Cruz-Díazb,c
a Servicio de Cardiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
b Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
c Servicio de Radiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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    "titulo" => "Pulmonary embolism during SARS-CoV-2 pandemic&#58; Clinical and radiological features"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Graph of COVID-19 incidence and PE in the reference population during the pandemic&#46; The lines represent the daily sum of cases during the previous 14 days for COVID-19 and for PE cases in the hospital&#8217;s reference population&#46; The scale of PE incidence is ten times lower than that of COVID-19&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PE&#58; pulmonary embolism&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Although coronavirus disease 2019 &#40;COVID-19&#41; fundamentally manifests as atypical pneumonia and severe acute respiratory syndrome&#44; it can affect other organs and systems&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Thrombotic complications have been described in various areas&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> frequently as pulmonary embolism &#40;PE&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;7</span></a> and PE series have been conducted in autopsies&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> intensive care units &#40;ICU&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#44;6</span></a> and patients hospitalized in conventional wards&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To the extent of our knowledge&#44; neither the change in PE incidence in the general population during the pandemic nor the possible differential characteristics of the PE that occurred during this period have been investigated&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Population and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a retrospective study using the radiology and electronic medical record archives of a university hospital in the Community of Madrid &#40;Spain&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Two time periods were defined&#58; the study period&#44; from March 01 to May 31&#44; 2020&#44; and a control period&#44; which was this same period in 2019&#46; During these periods&#44; all computed tomography pulmonary angiogram &#40;CTPA&#41; requests in which a clinical suspicion of PE was listed were identified&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The tests had been conducted using multidetector computed tomography &#40;CT&#41; &#40;Brilliance&#59; Philips&#44; Eindhoven&#44; the Netherlands&#41; following the standard protocols&#46; All were re-analyzed by two expert radiologists in order to detect intraluminal filling defects in the proximal or distal pulmonary arteries &#40;segmental or subsegmental&#41;&#46; The medical records of patients who were ultimately diagnosed with PE were retrieved and the predisposing clinical conditions included in the revised Geneva score<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> were recorded along with D-dimer&#44; determined by immunoturbidimetry &#40;STA&#174;-Liatest&#174; D-Di Plus&#44; Stago&#44; Asni&#232;res-sur-Seine&#44; France&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">During the study period&#44; the results of a real-time polymerase chain reaction &#40;RT-PCR&#41; for SARS-CoV-2 and time since COVID-19 symptoms onset and suspicion of PE were recorded&#46; The COVID-19 diagnosis was based on World Health Organization &#40;WHO&#41; criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The incidence of COVID-19 in the population served by the hospital was obtained by consulting public records&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test was used for qualitative variables &#40;expressed as proportions&#41;&#46; Means of the quantitative variables were compared using Spearman&#8217;s test &#40;for nonrelated variables&#41;&#44; expressed as mean&#160;&#177;&#160;standard deviation&#46; A value of <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;&#46;05 was considered significant&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The relative risk of PE between both periods was calculated based on the number of PE detected and the population attended to in each period with a 95&#37; confidence interval &#40;CI&#41;&#46; The data were analyzed with the IBM SPSS 22 program &#40;Armonk&#44; NY&#59; USA &#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study was approved by the hospital&#8217;s research ethics committee &#40;OE33&#47;2020&#41;&#44; which exempted it from the need to obtain consent&#44; given the study&#8217;s retrospective nature&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">During the control period&#44; a CTPA was ordered for suspicion of PE for 145 patients&#44; 22 of which &#40;15&#46;2&#37;&#41; were ultimately diagnosed with PE&#46; During the study period&#44; 465 CTPA were ordered for suspicion of PE&#44; 99 of which &#40;21&#46;3&#37;&#41; were confirmed and eight &#40;8&#37;&#41; of which were in patients hospitalized in the ICU&#46; A total of 74 had previously been diagnosed with COVID-19&#44; with a mean period between the diagnoses of 9&#46;1&#160;&#177;&#160;8&#46;4 days&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Of the 1292 patients hospitalized with a diagnosis of COVID-19 in this period&#44; 5&#46;7&#37; &#40;74&#41; were diagnosed with PE&#46; Considering the population served by the hospital&#44; the relative risk of PE during the study period compared to the control period was 4&#46;5 &#40;95&#37; CI 2&#46;80&#8211;6&#46;99&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the incidence curves for PE and COVID-19 estimated for the population served by the hospital&#46; They had a similar trend&#44; but PE occurred after a delay&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the rest of the results&#46; During the study period&#44; patients with PE were more frequently men &#40;69&#46;7&#37; vs&#46; 54&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;NS&#41; and there were no relevant differences in mean age &#40;65&#46;1&#160;&#177;&#160;19&#46;0 vs&#46; 66&#46;6&#160;&#177;&#160;15&#46;0&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;NS&#41;&#46; They had fewer episodes of prior PE &#40;5&#46;1&#37; vs&#46; 18&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;05&#41;&#44; deep vein thrombosis &#40;DVT&#41; &#40;11&#46;1 vs&#46; 45&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;0001&#41;&#44; and surgery in the previous month &#40;2&#37; vs&#46; 35&#46;4&#37;&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">D-dimer levels were higher in cases of PE associated with COVID-19 &#40;11&#46;9&#160;&#177;&#160;27&#46;5 vs&#46; 3&#46;4&#160;&#177;&#160;5&#46;0&#160;mg&#47;L&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;017&#41; and they tended to be higher&#44; though not significantly so&#44; during the study period&#46; PE were more frequently distal during the pandemic period &#40;73&#46;5&#37; vs&#46; 50&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;02&#41; and also in patients with COVID-19 versus those who did not have COVID-19 &#40;83&#46;6&#37; 57&#46;9&#37;&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;&#46;005&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Our study shows an increase in the incidence of PE during the first months of the pandemic&#44; with up to 4&#46;5 times greater risk compared to the same period the previous year&#46; It includes PE that were associated and not associated with COVID-19 in hospitalization wards &#40;91 cases&#41; as well as in the ICU &#40;eight cases&#41;&#46; The difference between both periods &#40;77 cases&#41; almost entirely coincides with cases of PE associated with COVID-19 &#40;74 episodes&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Some authors<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> have described a cumulative incidence of PE of 24&#37; in patients with COVID-19 in whom a CTPA is performed&#46; This piece of data leads to confusion&#59; it refers to the proportion of positive studies in patients who had the test performed for some reason and not the prevalence in the entire population hospitalized due to COVID-19&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Some meta-analyses have shown a high incidence of PE&#44; but the majority of cases included come from patients hospitalized in the ICU&#44; who have a greater incidence&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Thus&#44; the clearest information can be found in specific series&#46; In a series of 184 patients with COVID-19 hospitalized in three ICUs&#44; 25 &#40;13&#46;6&#37;&#41; had a PE&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> a similar figure &#40;16&#46;7&#37;&#41; to what was reported in a prospective analysis of 150 consecutive patients admitted in four other ICUs&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">On the other end&#44; a series of patients hospitalized in the internal medicine ward of a hospital had a PE incidence of 6&#46;2&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> similar to our finding of 5&#46;7&#37;&#46; Therefore&#44; around 6&#37; of patients hospitalized due to COVID-19 may have a PE&#44; with figures increasing to 13&#37;&#8211;17&#37; in critical cases in the ICU&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We have observed a delay between COVID-19 diagnosis and suspicion of PE&#44; which is clearly perceptible in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; In light of the foregoing&#44; we must be alert to signs of deterioration in COVID-19 patients after the first week of hospitalization&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">PE found during the pandemic period differed from those diagnosed in the previous year&#46; Patients had fewer predisposing conditions for having one and obstruction was more often distal&#46; The same was true when comparing patients with PE with and without COVID-19&#46; COVID-19 appears to be associated in and of itself with a greater risk of developing PE&#44; probably greater than what is described in other types of lung pneumonia&#44; in which distal PE is also more common&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Other authors have also found an increase in distal PE in patients with COVID-19<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and this could be at least in part due to the association of COVID-19 with in situ pulmonary thrombosis&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> An increase in other types of PE during the pandemic is in part to be expected&#44; given that lockdown could be a cause of immobility and there has been a dramatic increase in the number of critically ill patients with greater risk of PE&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Limitations</span><p id="par0105" class="elsevierStylePara elsevierViewall">The retrospective nature of this study does not allow for standardization of suspicion of PE&#46; A risk stratification was not conducted for the PE observed due to the small size of the sample&#46; DVT may not have been systematically investigated during the peak of the pandemic due to logistical reasons&#46; The majority of samples for RT-PCR were obtained using nasopharyngeal swabs&#44; a technique with an estimated sensitivity of 63&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Therefore&#44; some of the 25 cases of PE without a COVID-19 diagnosis could have been infected&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Estimated incidence of PE for the population is just an approximation&#44; there were many possible causes for a loss of cases that could cause an underestimation&#44; including patients who died in nursing homes and terminal cases which were not investigated&#46; In any case&#44; the real incidence of PE during the pandemic would be higher&#44; not lower&#44; than during the control period and would lend support to the initial hypothesis&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">It is also plausible that CT scans were underused due to the emergency situation&#46; Nevertheless&#44; a CTPA was ordered due to suspicion of PE in a third of patients hospitalized due to COVID-19 during the study period&#44; with a rate of confirmed diagnosis of 21&#46;3&#37;&#44; which was not statistically different from the rate found during the control period&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">When used correctly&#44; CTPA should detect PE in 30&#37; of all CTPAs ordered&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Therefore&#44; our data do not suggest underuse in any of the periods and are in agreement with the test&#8217;s diagnostic capacity in other studies conducted on patients with COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic is associated with a greater risk of PE&#46; This risk seems to increase one or two weeks following infection&#46; During the pandemic period&#44; PE affected patients with a different clinical profile who often had COVID-19&#46; In addition&#44; the obstruction of vessels was more frequently distal&#46; Our results support the hypothesis that COVID-19 is a risk factor for having a PE with specific characteristics&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">This research has not received specific grants from agencies in the public&#44; commercial&#44; or non-profit sectors&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest&#46;</p></span></span>"
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            1 => "Embolismo pulmonar"
            2 => "SARS-CoV-2"
            3 => "Coronavirus"
            4 => "Trombosis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A high incidence of pulmonary embolism has been described during the coronavirus pandemic&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a single-center retrospective study which reviewed computed tomography pulmonary angiograms ordered due to suspected pulmonary embolism during two periods&#58; from March 1&#44; 2020 to May 31&#44; 2020 &#40;pandemic&#41; and during the same interval in 2019 &#40;control&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Twenty-two pulmonary embolisms were diagnosed during the control period and 99 in the pandemic&#44; 74 of which were associated with COVID-19&#46; Of all patients hospitalized with COVID-19&#44; 5&#46;3&#37; had a pulmonary embolism&#44; with a delay between the two diagnoses of 9&#46;1&#160;&#177;&#160;8&#46;4 days&#46; During the pandemic&#44; patients with pulmonary embolism had fewer predisposing conditions &#40;previous pulmonary embolism 5&#46;1 vs&#46; 18&#46;2&#37;&#44; p&#160;&#61;&#160;&#46;05&#59; previous surgery 2 vs&#46; 35&#46;4&#37;&#44; p&#160;&#61;&#160;&#46;0001&#59; deep vein thrombosis 11&#46;1 vs&#46; 45&#46;5&#37;&#44; p&#160;&#61;&#160;&#46;0001&#41;&#59; peripheral pulmonary embolisms were the most frequent &#40;73&#46;5 vs&#46; 50&#37;&#44; p&#160;&#61;&#160;&#46; 029&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">There is an increased risk of having a pulmonary embolism during the SARS-CoV-2 pandemic&#44; which affects patients with a different clinical profile and more often causes distal pulmonary embolisms&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se ha descrito una elevada incidencia de tromboembolismo pulmonar &#40;TEP&#41; durante la pandemia por coronavirus&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo unic&#233;ntrico&#44; con revisi&#243;n de las angiograf&#237;as pulmonares por tomograf&#237;a computarizada solicitadas por sospecha de tromboembolismo pulmonar durante dos per&#237;odos&#44; del 01 de marzo del 2020 al 31de mayo del 2020 &#40;pandemia&#41;&#44; e igual intervalo en 2019 &#40;control&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se diagnosticaron 22 tromboembolismos pulmonares durante el per&#237;odo control y 99 en el pand&#233;mico&#44; 74 asociados con COVID-19&#46; El 5&#44;3&#37; de los pacientes hospitalizados con COVID-19 sufri&#243; un tromboembolismo pulmonar&#44; con un retraso entre ambos diagn&#243;sticos de 9&#44;1&#160;&#177;&#160;8&#44;4 d&#237;as&#46; Durante la pandemia&#44; los pacientes con tromboembolismo pulmonar ten&#237;an menos condiciones predisponentes &#40;tromboembolismo pulmonar previo 5&#44;1 vs&#46; 18&#44;2&#37;&#44; p&#160;&#61;&#160;0&#44;05&#44; cirug&#237;a previa 2 vs&#46; 35&#44;4&#37;&#44; p&#160;&#61;&#160;0&#44;0001&#44; trombosis venosa profunda 11&#44;1 vs&#46; 45&#44;5&#37;&#44; p&#160;&#61;&#160;0&#44;0001&#41;&#44; y los tromboembolismos pulmonares perif&#233;ricos eran m&#225;s frecuentes &#40;73&#44;5 vs&#46; 50&#37;&#44; p&#160;&#61;&#160;0&#44;029&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Existe un riesgo incrementado de sufrir un TEP durante la pandemia por SARS-CoV-2&#44; que afecta a pacientes con perfil cl&#237;nico diferente y causa m&#225;s frecuentemente TEP distales&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a-Lled&#243; A&#44; del Palacio-Salgado M&#44; &#193;lvarez-Sanz C&#44; P&#233;rez-Gil MM&#44; Cruz-D&#237;az &#193;&#46; Tromboembolismo pulmonar durante la pandemia por SARS-CoV-2&#58; caracter&#237;sticas cl&#237;nicas y radiol&#243;gicas&#46; Rev Clin Esp&#46; 2022&#59;222&#58;354&#8211;358&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2902
            "Ancho" => 2925
            "Tamanyo" => 185743
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Graph of COVID-19 incidence and PE in the reference population during the pandemic&#46; The lines represent the daily sum of cases during the previous 14 days for COVID-19 and for PE cases in the hospital&#8217;s reference population&#46; The scale of PE incidence is ten times lower than that of COVID-19&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PE&#58; pulmonary embolism&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; LDH&#58; lactate dehydrogenase&#59; bpm&#58; beats per minute&#59; death&#58; in-hospital death&#59; CRP&#58; C-reactive protein&#59; RR&#58; relative risk&#59; RT-PCR&#58; reverse-transcription polymerase chain reaction&#59; Sat O<span class="elsevierStyleInf">2</span>&#58; oxygen saturation&#59; DVT&#58; deep vein thrombosis&#59; ICU&#58; intensive care unit admission&#59; NS&#58; not significant&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Period</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Significance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RR 4&#46;5 &#40;95&#37; CI 2&#46;80&#8722;6&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex &#40;male&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;54&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;69&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;1&#160;&#177;&#160;19&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;6&#160;&#177;&#160;15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COVID-19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Previous PE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;18&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery in the past month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;35&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Active neoplasm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;27&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DVT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peripheral PE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;73&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart rate &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">Fibrinogen mg&#47;dL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">D-dimer mg&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ferritin &#951;gr&#47;mL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ICU&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical and radiological data of patients with a diagnosis of pulmonary embolism &#40;PE&#41; during the control period &#40;2019&#41; and the pandemic period &#40;2020&#41;&#46;</p>"
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                      "titulo" => "Organ-specific manifestations of COVID-19 infection"
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                          "etal" => true
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                            0 => "M&#46; Gavriatopoulou"
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                            2 => "D&#46; Fotiou"
                            3 => "I&#46; Ntanasis-Stathopoulos"
                            4 => "T&#46; Psaltopoulou"
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