Pulmonary embolism in pediatric age: a retrospective study from a
Introduction: Pediatric pulmonary embolism (PE) is rare but associated
with adverse outcomes. We aimed to characterize PE cases admitted in a
tertiary hospital and to evaluate sensitivity of PE diagnostic
prediction tools. Methods: Retrospective, descriptive study of PE cases
admitted from 2008 to 2020. Data was collected from hospital records.
Patients were grouped according to PE severity and setting (outpatients,
inpatients). Associations with demographic characteristics, risk
factors, clinical presentation, management and outcomes were analyzed.
PE diagnostic prediction tools were applied. Results: 29 PE episodes
occurred in 27 patients, 62.9% female, mean age 14.1 years. Most PE
were central and massive or submassive. One was diagnosed in autopsy.
Outpatients (n=20), admitted for classic PE symptoms, were adolescents;
in half the diagnosis had been missed previously. Risk factors included
contraceptives (65%), thrombophilia (35%), obesity (20%) and
auto-immunity (20%). Inpatients´ PE (n=8), diagnosed during
cardiorespiratory deterioration (n=5) or through incidental radiological
findings (n=3), were younger and had immobilization (87.5%), complex
chronic diseases (75%), infections (75%) and central venous catheter
(62.5%) as risk factors. Retrospectively, D-dimer testing and adults’
scores performed better than pediatrics’ scores (sensitivity 92.9-96%
vs 85.7- 92.9%). Both pediatrics’ scores missed a case with a positive
family history. Discussion: Pediatric PE diagnosis is often delayed or
missed. To improve it, the development of pediatric prediction tools as
from validated adult scores merits to be explored. We propose that
clinical presentation and risk factors may be different in inpatients
and outpatients. Family history should be included.