Comparative Review Between Massive, Sub-massive, and Non-Massive Pediatric Pulmonary Embolism: A Systematic Review

Abstract

Objective:To evaluate the current evidence on the diagnosis, management, and outcomes of pediatric pulmonary embolism (PE) across varying severity classifications, including massive, submassive, and non-massive presentations. Methods:A systematic review was conducted following PRISMA guidelines, searching PubMed, Scopus, Web of Science, and Cochrane databases up to February 17, 2024. Eligible studies included pediatric and adolescent patients (≤ 21 years) with confirmed PE diagnosis, comparing different severities of the disease. Results:Six studies involving 258 pediatric patients with massive, submassive, or non-massive PE were included. The majority of patients were adolescents, with varied presentations and risk factors such as obesity, oral contraception use, and thrombophilia. Diagnostic modalities included computed tomography pulmonary angiography, with differing rates of lobar, segmental, and subsegmental involvement. Management strategies ranged from anticoagulation therapy to aggressive interventions such as catheter-directed thrombolysis and surgical thrombectomy. Outcome measures included mortality, recurrence rate, complications, and chronic thromboembolic pulmonary hypertension. Conclusion:Tailored risk stratification and management approaches for pediatric PE is crucial for prompt diagnosis and good prognosis. While most patients respond favorably to therapy, those with diagnostic delays or more severe disease have higher likelihood of morbidity and mortality. Future studies are needed to explore novel diagnostic modalities and to conduct comparative assessments of therapeutic interventions to optimize outcomes for pediatric PE patients (ID: CRD42024517245).