275: Surprising Clinical Associations With Pneumothorax and Pneumomediastinum in COVID-19

INTRODUCTION: The SARS-CoV2 pandemic experienced its height in the New York City (NYC) area in April of 2020 Flushing Hospital is a predominantly minority community hospital in Queens, NY, at that time the borough with the largest number of COVID-19 cases in NYC An unexpectedly high incidence of pneumothorax (PTX) and pneumomediastinum (PMX) cases were noted during our experience METHODS: This is a single-center, retrospective, casecontrol study of patients admitted between March 10 and April 30, 2020 who were PCR SARS-CoV2 positive with respiratory failure Presented here is our preliminary data on the first 196 charts reviewed Presence of PTX and/ or PMX was determined by investigator review of all chest imaging during patient admission Demographic and clinic characteristics of patients were extracted RESULTS: Of the 196 patients, 7 (3 6%) developed both PTX+PMX, 7 (3 6%) only PTX, and 8 (4 1%) only PMX, for a total incidence rate of 11 3% for PTX+/-PMX Patients with PMX+/-PTX had 40% mortality, those with PTX+/-PMX had 64% mortality, and those with neither had a 42% mortality rate (difference between PTX group and no PTX/PMX group, X2=2 61, p= 11) Obesity, HTN, COPD/asthma, CAD, CHF, and CKD were not significantly higher in the PTX+/- PMX groups Diabetic patients were more likely to develop PTX+/-PMX (16% vs 7%, p= 05) Patients who developed PTX+/-PMX were more likely to be intubated (83% vs 33%, p< 005);however, tidal volume (Vt) and maximum PEEP were not associated with development of PTX+/-PMX Males were more likely to develop PTX+/-PMX than females (15% vs 6%, p= 05) Median d-dimer was significantly higher in the PTX+/-PMX group (22,522 vs 5,628, p< 005) CONCLUSIONS: The overall occurrence of PTX+/-PMX was 11 3% in patients with COVID-19 respiratory failure Mortality in patients with PTX was 50% higher than in patients without PTX (64% vs 42%) Of the clinical characteristics collected, diabetes and elevated d-dimer was highly associated with the development of PTX+/-PMX, and surprisingly Vt and PEEP played no statistically significant role Although this is a preliminary analysis of approximately the first 20% of our data, the results are indicative of a substantial incidence of PTX and PMX in patients with COVID-19 and sheds light on predictors and clinical course