Pulmonary embolism in pediatric age: A retrospective study from a tertiary center

• Type: Article in International Scientific Journal
• Date: 2021

Authors

de Braganca, RL (Author) Other; Gorito, V (Author) Other; Cibele, DG (Author) Other; Goncalves, LR (Author) Other; Ribeiro, A (Author) Other; Baptista, MJ (Author) Other; Inês Azevedo (Author) FMUP

Journal

Title: Pediatric Pulmonology

Vol. 56

Pages: 2751-2760

ISSN: 8755-6863

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 10 Citations

Scopus - 13 Citations

Other information

Authenticus ID: P-00V-43J

DOI: 10.1002/ppul.25527

Abstract (EN): 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 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.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 10