Additional analysis of pediatric pulmonary embolism using the Pediatric Health Information System database

Abstract

We read the article by Carpenter et al 1 with interest because it provides crucial information on the trends in pediatric pulmonary embolism (PPE) in the United States. Similarly, we conducted an analysis of the Pediatric Health Information System (PHIS) database (initiated prior to the aforementioned publication), with an aim to identify features associated with mortality and recurrent PPE. PHIS is an administrative database that contains clinical and resource utilization data for inpatients from 45 not-for-profit tertiary-care hospitals throughout the United States. Participating hospitals provide discharge data, including patient demographic data, diagnoses, and procedure codes. 2 Carpenter et al 1 analyzed children up to 18 years of age in the PHIS database from 2001 to 2014, whereas we analyzed the PHIS database between 2004 and 2017 and used the International Classification of Diseases, Ninth Revision (ICD-9) (415.11, 415.12, 415.13, 415.19) and ICD-10 (I26.01, I26.02, I26.09, I26.90, I26.92, I26.99) diagnostic codes (PHIS began using ICD-10 codes in 2015). Additionally, we included patients ,21 years of age based on the National Institute of Child Health and Human Development pediatric age definition. 3 Although Carpenter et al 1 evaluated pulmonary embolism (PE) rate and compared it with venous thromboembolism (VTE) discharges and all hospital discharges, for other variables (eg, sex, mortality, CCC risk factors for recurrence) they primarily compared PE patients with VTE patients. We analyzed the PPE cohort and compared demographics of this cohort with all hospital admissions. Additionally, we evaluated risk factors for recurrent PE (subsequent admission with an ICD code for PE) and mortality within 2 years of the index PE event, using univariate analysis and multivariate analysis with a Cox proportionate hazards model. Consequently, we identified additional risk factors and characterizations for PPE that we believe are informative and worth reporting.

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

“…We found an overall predominance of female patients, especially in the adolescent group, presumably due to the influence of CHC. The mean age at presentation was similar to those described in other reviews, 8 although, as also reported elsewhere, 7,16 the classical bimodal age distribution associated with pediatric PE 4,10,19 was not found. PE is probably underdiagnosed, especially in infants, whose diagnosis is even more challenging due to the unspecific clinical presentation.…”

Pulmonary embolism in pediatric age: a retrospective study from a tertiary Centre

“…We found an overall predominance of female patients, especially in the adolescent group, presumably due to the influence of CHC. The mean age at presentation was similar to that described in other reviews 8 , however, as others 7,16 , we didn t find the classical bimodal age distribution described in pediatric PE 4,10 . PE is probably underdiagnosed, especially in infants, whose diagnosis is even more challenging due to the unspecific clinical presentation.…”

“…Given its rarity, most pediatric studies include venous thrombosis and thromboembolism (VTE), whereas PE only accounts for approximately 15% of VTE episodes 7 . The lack of well-performing pediatric probability models to assist in PE diagnosis is concerning 8,10 . Adult validated diagnostic prediction tools, such as the Wells criteria 11 and the Pulmonary Embolism Rule-out Criteria (PERC) tool 12 , are often used 13 .…”

Venous Thromboembolism among Critically Ill Children: A Narrative Review

“…32 These data are consistent with work by Rajpurkar and colleagues noting pediatric PE incidence rates increased from 5.1 to 9.2 per 10,000 admissions from 2004 to 2017. 33 More common to neonates, CSVT incidence rates have increased from 2.6 per 100,000 newborns in 2000 to 12 per 100,000 in 2007. 34 Rising estimates for the occurrence of pediatric VTE are not likely to be driven by temporal changes toward an intrinsically more prothrombotic pediatric phenotype (although this may be a contributing factor, in association with the pandemic of obesity), but rather by a combination of heightened VTE awareness, increasingly selective and automated hospital screening measures, greater use and duration of CVCs, more sensitive imaging techniques, and improved identification of previously asymptomatic cases among critically ill children.…”