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Pulmonary embolism in pediatric age: A retrospective study from a tertiary center
Author(s) -
Lopes de Bragança Raquel,
Gorito Vanessa,
Cibele Diana Gonçalves,
Ricca Gonçalves Luciana,
Ribeiro Augusto,
Baptista Maria João,
Azevedo Inês
Publication year - 2021
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25527
Subject(s) - medicine , retrospective cohort study , pulmonary embolism , pediatrics , family history , medical record
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 selected PE diagnostic prediction tools. Methods Retrospective, descriptive study of PE cases admitted from 2008 to 2020 using data collected from hospital records. Patients were grouped according to PE severity and setting (outpatients vs. inpatients). Links and correlation with demographic characteristics, risk factors, clinical presentation, management, and outcomes were analyzed. PE diagnostic prediction tools were applied. Results Twenty‐nine PE episodes occurred in 27 patients, 62.9% female, mean age 14.1 years. Most PE were central and split between massive or submassive. One was diagnosed in autopsy. Twenty outpatients, all adolescents, were admitted for classic PE symptoms; in half of them the diagnosis had been previously missed. Risk factors included contraceptives (65%), thrombophilia (35%), obesity (20%) and auto‐immunity (20%). Eight inpatients, 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 adult scores performed better than pediatric scores (sensitivity 92.9%–96% vs. 85.7%–92.9%). Both pediatric scores missed a case with a positive family history. Discussion Pediatric PE diagnosis is often delayed or missed. Development of pediatric prediction tools from validated adult scores merits being explored. We argue clinical presentation and risk factors may be different in inpatients and outpatients and propose broader reliance on family history.