INTRODUCTION
Pulmonary embolism (PE) is rare in pediatric age, with an estimated
incidence inferior to 1:100.000 in general pediatric
population1,2. In the last decade, incidence increased
in both community and hospitalized children3,5-7,
although it is underdiagnosed, as evidenced by autopsy-based
studies3,4. PE is associated with a high rate of
adverse outcomes, with mortality up to 26%3,6,8. In
pediatric age, almost all the events are associated with at least one
risk factor or underlying disorder9. Pediatric PE
occurs mostly in infants and teenagers1,2 and in this
last group occurs twice as much in females, due to estrogen related risk
factors such as pregnancy or combined hormonal contraceptives
(CHC)2.
There is a paucity of data on pediatric PE. Given its rarity, most
pediatric studies include venous thrombosis and thromboembolism (VTE),
whereas PE only accounts for approximately 15% of VTE
episodes7. The lack of well-performing pediatric
probability models to assist in PE diagnosis is
concerning8,10. Adult validated diagnostic prediction
tools, such as the Wells criteria11 and the Pulmonary
Embolism Rule-out Criteria (PERC) tool12, are often
used13. However, they seem to lack sensitivity and
specificity in the pediatric population14,15.
Pediatric models have been proposed15,16 but were
based in a small number of PE patients from single centers. PE
management in children and adolescents are also often extrapolated from
adult studies9, a population with different
pathophysiology, morbidity and mortality. Thus, pediatric studies are
needed to improve diagnostic tools, risk stratification and treatment
options.
We intended to characterize patients with PE admitted in a tertiary
hospital regarding their clinical presentation, risk factors, severity
classification, treatment and outcomes. Secondarily, we intent to
investigate the sensitivity of PE diagnostic prediction tools in this
population.