Detection of Pulmonary Embolism in High-Risk Children

Hennelly, Kara; Baskin, Marc N.; Monuteuax, Michael C.; Hudgins, Joel; Kua, Eugene; Commeree, Ashlee N.; Kimia, Rotem; Lee, Edward Y.; Kimia, Amir A.; Neuman, Mark I.

doi:10.1016/j.jpeds.2016.07.046

Cited by 46 publications

(75 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among 27 PE+ children, Biss et al found four cases with normal D-dimer, yielding an unacceptably low diagnostic sensitivity of 85% and a lower limit 95% CI of 66%; moreover, 2/27 children had a ‘PE Unlikely’ Wells score (defined as <5 in this study) and a normal D-dimer. Among 503 young adults and mostly adolescents (age <22 years), Hennelly et al found the D-dimer to have a sensitivity of 79% (95% CI 60% to 91%) and a specificity of 69% (95% CI 65% to 94%) 9. These data clearly do not support adoption of the D-dimer in children.…”

Section: Introductionmentioning

confidence: 98%

Diagnostic accuracy of the D-dimer in children

et al. 2017

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 98%

Diagnostic accuracy of the D-dimer in children

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Pulmonary embolism (PE) occurs in only about 0.86 in 10 000 children in the general population each year but carries a high risk of mortality (~10%) . When PE is considered in a differential diagnosis, there is considerable decisional conflict because the clinical presentation of PE overlaps with many common pediatric diseases.…”

Section: Introductionmentioning

confidence: 99%

“…When PE is considered in a differential diagnosis, there is considerable decisional conflict because the clinical presentation of PE overlaps with many common pediatric diseases. The current criterion standard for PE diagnosis is computed tomography pulmonary angiogram (CTPA), but this carries the risk of radiation‐induced malignancy . Balancing the risk of missing a PE against the probable increased risk of a radiation‐induced malignancy presents a clinical conundrum for emergency medicine physicians caring for children.…”

Section: Introductionmentioning

confidence: 99%

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

Hennelly

Ellison

Neuman

et al. 2020

Research and Practice in Thrombosis and Haemostasis

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…older population in the emergency setting, who are perhaps more akin to adults presenting with suspected PE 6. D-dimer would appear to have poor discriminatory value in the diagnosis of childhood PE, at least in a tertiary care setting.…”

mentioning

confidence: 97%

“…This lack of specificity reduces the negative predictive value of the test with only a small proportion not requiring imaging. Hennelly et al 6 reported slightly better performance of the D-dimer in an…”

mentioning

confidence: 98%

Pulmonary embolism in childhood: how can we be sure not to miss it?

Biss

2018

Arch Dis Child

View full text Add to dashboard Cite

Detection of Pulmonary Embolism in High-Risk Children

Cited by 46 publications

References 25 publications

Diagnostic accuracy of the D-dimer in children

Diagnostic accuracy of the D-dimer in children

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

Pulmonary embolism in childhood: how can we be sure not to miss it?

Contact Info

Product

Resources

About