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Analysis of predictive factors in children with high suspicion of pulmonary embolism
Abdurrahman Erdem Başaran1, Ayşen Başaran1, Suzan Yılmaz Durmuş1
1Department of Pediatrics, Division of Pulmonology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
Insights
A new model identifies predictive factors for pediatric pulmonary embolism (PE), showing higher specificity than existing Wells, PERC, and PPE criteria for diagnosing PE in children.
Area of Science:
- Pediatric Medicine
- Cardiology
- Radiology
Background:
- Existing pulmonary embolism (PE) predictive models (Wells, PE Rule-out Criteria [PERC]) are validated for adults, not children.
- Lack of pediatric-specific models necessitates evaluating adult criteria in pediatric populations.
Purpose of the Study:
- Identify predictive factors for PE in pediatric patients.
- Assess the effectiveness of Wells criteria, PERC, and pediatric-specific PE (PPE) criteria.
- Develop and validate a novel predictive model for pediatric PE.
Main Methods:
- Retrospective analysis of 110 pediatric patients (0-18 years) with suspected PE.
- Inclusion of demographic data, symptoms, physical exam findings, risk factors, and lab/imaging results.
- Application of Wells, PERC, and PPE criteria to the study cohort.
Main Results:
- 24.5% of pediatric patients had PE; key predictors included saturation, albumin, cough, calf swelling, central catheter, and malignancy.
- Developed model achieved an AUC of 0.79 (77% sensitivity, 70% specificity) with a cutoff >6.5.
- Wells criteria: 96% sensitivity, 24% specificity; PERC: 96% sensitivity, 21% specificity; PPE: 74% sensitivity, 30% specificity.
Conclusions:
- The developed model demonstrates superior specificity compared to Wells, PERC, and PPE criteria for pediatric PE.
- While existing criteria offer high sensitivity, their low specificity may lead to unnecessary testing in children.
- Further validation of the novel model is recommended for clinical application in diagnosing pediatric PE.
Background And Aim:
Since there is a limited number of predictive models designed for pediatric patients with pulmonary embolism (PE), healthcare providers have resorted to utilizing the Wells criteria and PE Rule-out Criteria (PERC) that have been validated for use in adults. The objective of the study is to identify the predictive factors for PE and assess the effectiveness of the PERC, Wells, and pediatric-specific PE (PPE) criteria.
Methods:
The study included individuals between the ages of 0-18 years who underwent pulmonary CT angiography and/or ventilation-perfusion scintigraphy with suspicion of PE. Demographic characteristics, symptoms, physical examination findings, risk factors, and laboratory and imaging results were retrospectively analyzed, and PERC, Wells, and PPE criteria were applied to the study population.
Results:
Of the 110 patients included in the study, 27 (24.5%) had PE. Saturation, albumin, cough, calf swelling, central catheter, and malignancy were found to significantly contribute to the model. The total weighted risk score, which represents the sum of all predictive scores, ranged from 0 to 16 with a mean of 5.41 ± 4.02. When the cut-off >6.5, the model had good discrimination power for positive PE (AUC 0.79, 77% sensitivity, and 70% specificity). In our study, the Wells criteria showed a sensitivity of 96% and a specificity of 24%. The PERC exhibited a sensitivity of 96% and a specificity of 21%, while the PPE demonstrated a sensitivity of 74% and a specificity of 30%.
Conclusion:
While the sensitivity of Wells, PERC, and PPE models was higher than our developed model, their specificities were considerably lower than our model.
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