Clinical variables that increase the probability of pulmonary embolism diagnosis in symptomatic children

Abstract

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: Pulmonary embolism (PE) in children carries a significant morbidity and mortality. We examined previously described factors in 2 cohorts of children tested for PE and identified novel factors. Methods:We combined data from 2 retrospective cohorts. Patients up to age 21 years were included who underwent imaging or D-dimer testing for PE, with positive radiologic testing being the gold standard. Combined predictor variables were examined by univariate analysis and then forward stepwise multivariable logistic regression. Results: The combined data set yielded 1103 patients with 42 unique predictor variables, and 93 PE-positive patients (8.4%), with a median age of 16 years. Univariate analysis retained 17 variables, and multivariable logistic regression found 9 significant variables with increased probability of PE diagnosis: age-adjusted tachycardia, tachypnea, hypoxia, unilateral limb swelling, trauma/surgery requiring hospitalization in previous 4 weeks, prior thromboembolism, cancer, anemia, and leukocytosis. Conclusion: This combined data set of children with suspected PE discovered factors that may contribute to a diagnosis of PE: hypoxia, unilateral limb swelling, trauma/ surgery requiring hospitalization in previous 4 weeks, prior thromboembolism, and cancer, age-adjusted tachycardia, tachypnea, anemia, and leukocytosis. Prospective testing is needed to determine which criteria should be used to initiate diagnostic testing for PE in children. Essentials• Pulmonary embolism (PE) in children carries a significant morbidity and mortality.• We combined data from 2 retrospective cohorts and identified novel predictor variables.• Multivariable logistic regression found 9 significant variables associated with PE diagnosis.• Prospective testing is needed to determine which features predict pediatric PE diagnosis.

COVID-19 Infection and Acute Pulmonary Embolism in an Adolescent Female With Sickle Cell Disease

“…PE and venous thromboembolism (VTE) have been reported to be known complications of COVID-19 infections [ 1 ]. Multiple cases of PE have been reported in patients with poor or worsening respiratory status in the adult population [ 3 ]. Patients often present with tachypnea, dyspnea, hypotension, and elevated D-dimer and fibrinogen [ 3 ].…”

“…Multiple cases of PE have been reported in patients with poor or worsening respiratory status in the adult population [ 3 ]. Patients often present with tachypnea, dyspnea, hypotension, and elevated D-dimer and fibrinogen [ 3 ].…”

“…In general, pediatric patients have fewer comorbidities and risk factors for PE compared with the adult population. Annually, PE occurs in 0.86 of 10,000 children in the general population [ 3 ]. The risk factors for developing VTE include recent surgery, trauma, obesity, prolonged immobilization, initiation of hormone therapy, active cancer, and cigarette smoking [ 3 ].…”

“…Annually, PE occurs in 0.86 of 10,000 children in the general population [ 3 ]. The risk factors for developing VTE include recent surgery, trauma, obesity, prolonged immobilization, initiation of hormone therapy, active cancer, and cigarette smoking [ 3 ]. Of the many genetic risk factors, the common ones include Factor V Leiden mutation and prothrombin gene mutation.…”

“…One of the many complications of this disease includes a chronic hypercoagulable state, which can increase the risk of thromboembolic events [ 2 ]. This hypercoagulable state complicated the disease course of our patient, leading to the development of pulmonary emboli [ 3 , 4 ].…”