Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

Abstract

Key Points• Rates of pediatric PE in hospitalized patients increased 184% from 2001 to 2014.• Mortality as a result of PE in children has decreased over time and is now comparable to that from VTE.Although rare in children, pulmonary embolism (PE) can cause significant morbidity and mortality. Overall rates of venous thromboembolism (VTE) are increasing in hospitalized children. By using the Pediatric Health Information System database, we evaluated incidence, treatment, and outcome of PE in children younger than age 18 years from 2001 to 2014.Demographic characteristics for those admitted with VTE alone and those admitted with PE were compared. Rates of PE by year were compared with the number of hospital and VTE admissions. Trends in medication use were analyzed. Over the period of the study, patients with PE made up 15.8% of VTE discharges. The overall rate of PE increased 200%(P , .001). Compared with all other age groups, adolescents (age 13-18 years) had the highest prevalence (55%; P , .001), the rate of which increased from 9.8 to 24.7 per 10 000 hospital discharges (152%; P , .001), and from 17.5 to 34.1 per 100 VTE discharges (95%; P , .001). Individuals with PE had a higher mortality (8.3% vs 6%; P , .001) and were less likely to have a complex chronic condition (58% vs 65%; P , .001) than those with VTE alone. However, PE mortality rates decreased over the time period studied. AfricanAmerican and Hispanic patients were more likely to experience recurrent PE than white patients (12% and 10.7% vs 8%; P 5 .002). During the study period, the use of unfractionated heparin decreased (P , .001), and the use of low molecular weight heparin increased (P , .001). Further research is required to determine what factors contribute to the higher rate of PE in adolescents and influence recurrence in African American and Hispanic patients.

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

“…In their study, Carpenter et al 1 reported that the proportion of males with PE was higher than females (54% vs 46%) except within the 13-to 18-year-old age group. This proportion is identical to the total number of males vs females admitted to PHIS hospitals in our study (males: 3 924 860/7 267 444 [54%] and females: 3 341 644/7 267 444 [46%]; 940 hospitalizations had a missing value for sex), as well as to what has been reported in other PHIS studies.…”

“…Our study has several limitations. We used ICD-9 (similar to those used by Carpenter et al 1 ) and ICD-10 codes for identification of cases. These include codes for septic PE, as well as the ICD-9 codes used by Carpenter et al 1 for cancer and PE.…”

The effect of troponin values on prognosis in acute pulmonary embolism

“…The specificity and sensitivity values that can be used and which show the value of troponin values in terms of predicting mortality are shown in Tables 3 and 4. 4,5 It is responsible for 5-15% of all hospital deaths. In contrast, the annual incidence is considered to be higher than current data, given deaths that do not present clinical symptoms or undiagnosed deaths.…”

The components and activities analysis of noval anticoagulant candidate dHG-5

“…Cardiovascular disease has been causing high morbidity and mortality in worldwide (Benjamin, Virani et al , 2018;Timmis, Townsendet al , 2017). Among which, venous thromboembolism, such as deep venous thrombosis and pulmonary embolism, is one of the main complications of major surgery and cancer, et al , which remains to be a global disease burden (Becattini, Cohen et al , 2016;Carpenter, Richardson et al , 2018;Jiménez, Bikdeli et al , 2019).…”