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ForwardWMJ Vol 122 Issue 5: Incidence and Prognosis of Pneumothorax and Pneumomediastinum in Hospitalized Patients With COVID-19 Pneumonia
ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) can cause multisystem complications, with pulmonary involvement associated with the highest mortality. Pneumothorax (PT) and pneumomediastinum (PM) are uncommon complications of COVID-19 that have been reported to occur in the absence of trauma or mechanical ventilation. This study seeks to determine the incidence of these complications in patients with COVID-19 and evaluate clinical characteristics and outcomes.
Methods: We identified 3375 patients admitted to our health system during March 2020 through November 2020 who tested positive for SARS-CoV-2 with a polymerase chain reaction test. Patients were screened for PT or PM and were matched to COVID-19–positive patients without PT and/or PM. Data compared demographics, clinical characteristics, and laboratory values.
Results: Out of a total of 3375 COVID-19 admissions, 33 patients with PT/PM (1%) were compared to 32 matched controls without PT and/or PM. The patients with PT and/or PM demonstrated a significantly higher incidence of concomitant cancer diagnosis than those without PT and/or PM (18% vs 3%, respectively; P = 0.05). Those with PT and/or PM required significantly more invasive mechanical ventilation than those without PT and/or PM (79% vs 47%; P < 0.01). Mortality was significantly higher among those patients with PT and/or PM than those without PT/PM (55% vs 25%; P < 0.05).
Discussion: A significant number of COVID-19 patients with PT and/or PM had a concomitant cancer diagnosis, required supplemental oxygen on admission, and invasive mechanical ventilation during hospitalization. Additionally, the COVID patients with PT and/or PM had significantly higher mortality compared to those without PT and/or PM. However, with all retrospective studies, there are limitations.
Intended Audience
The target audience for this journal-based activity is healthcare providers caring for the people and communities of Wisconsin and beyond.
Learning Objectives
As a result of this journal-based activity, learners, as members of the healthcare team, will be able to:
- Discuss possible mechanisms for the development of pneumothorax and pneumomediastinum as complications in patients with COVID-19.
- Explain the results of this retrospective chart review study demonstrating that COVID-19–positive patients with pneumothorax and pneumomediastinum had higher morbidity and mortality than those who did not develop this complication.
- Summarize the study findings about patients with pneumothorax/pneumomediastinum requiring mechanical ventilation.
FACULTY DISCLOSURE
It is the policy of the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) to identify, mitigate and disclose all relevant financial relationships with ineligible companies* held by the speakers/presenters, authors, planners, and other persons who may influence content of this accredited continuing education (CE). In addition, speakers, presenters and authors must disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation.
For this accredited continuing education activity all relevant financial relationships have been mitigated and detailed disclosures are listed below.
| Name of Individual | Individual's Role in Activity | Financial Relationship Disclosure | Discussion of |
| Ahad Azeem, MD | Author | No relevant relationships with ineligible companies to disclose | No |
| Dua Noor Butt, MD | Author | No relevant relationships with ineligible companies to disclose | No |
| Margaret Carrig, BS | Author | No relevant relationships with ineligible companies to disclose | No |
| Bryan Krajicek, MD | Author | No relevant relationships with ineligible companies to disclose | No |
| Christopher Destache, Pharm D | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| Manasa Velagapudi, MBBS | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| Fahad Aziz | Editor | No relevant relationships with ineligible companies to disclose | No |
| Karol Kremens, MD | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| John Scott Ferguson, MD | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| Shezad Baloch | Accreditation Specialist | No relevant relationships with ineligible companies to disclose |
*Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on, patients.
The ACCME does not consider providers of clinical services directly to patients to be ineligible companies.
Accreditation
Accreditation Statement
 | In support of improving patient care, this activity has been planned and implemented by the University of Wisconsin–Madison ICEP and the Wisconsin Medical Journal. The University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. |
Credit Designation Statements
American Medical Association (AMA)
The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
American Nurses Credentialing Center (ANCC)
The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 ANCC contact hour.
American Academy of Physician Assistants (AAPA)
 | The University of Wisconsin–Madison ICEP has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until 04/01/2025. PAs should only claim credit commensurate with the extent of their participation. |
Continuing Education Units
The University of Wisconsin–Madison ICEP, as a member of the University Professional & Continuing Education Association (UPCEA), authorizes this program for 0.1 continuing education units (CEUs) or 1 hour.
Available Credit
- 1.00 AAPA Category 1 CME
- 1.00 AMA PRA Category 1 Credit™
- 1.00 ANCC Contact Hours
- 1.00 University of Wisconsin–Madison Continuing Education Hours
- 1.00 Approved for AMA PRA Category 1 Credit™
Registration for this activity can only be completed through the ICEP Learning Portal. Attendee registrations made through any other sites cannot be honored. UW-Madison ICEP is not able to refund fees paid through unaffiliated registration sites, such as eMedEvents.com, MedConfWorld.com, EventEgg.com, and 10times.com. Please report any unauthorized websites or solicitations for registrations to help@icep.wisc.edu.
Accessibility
The University of Wisconsin provides equal opportunities in employment and programming, including Title IX requirements. The University of Wisconsin fully complies with the legal requirements of the ADA and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please notify us at help@icep.wisc.edu
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