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Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet
Published on: November 4, 2015
Pediatric pulmonary thromboembolism: a 3-year Canadian Pediatric Surveillance Program study
Kristina Krmpotic1, Lily Ramsay2, Sarah McMullen3
1Department of Pediatric Critical Care, IWK Health, Halifax, Nova Scotia, Canada; Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Pediatric pulmonary embolism (PE) is rare but serious. Female adolescents are most at risk, and early suspicion is key for diagnosis and treatment in children.
Area of Science:
- Pediatric Medicine
- Cardiology
- Pulmonology
Background:
- Pediatric pulmonary embolism (PE) is an uncommon condition with significant potential for morbidity and mortality.
- Prompt identification and management are crucial for improving outcomes in children.
Purpose of the Study:
- To determine the incidence, risk factors, clinical presentation, and diagnostic and therapeutic practices for pediatric PE.
- To evaluate the short-term outcomes of children diagnosed with PE.
Main Methods:
- A 3-year national surveillance study was conducted using the Canadian Pediatric Surveillance Program.
- Over 2800 pediatric specialists reported new cases of PE in patients up to 18 years of age.
- Data were collected via voluntary questionnaires from 2020 to 2022.
Main Results:
- Fifty-eight cases of pediatric PE were reported, equating to 2.4 cases per million children.
- Adolescents aged 15-18 years had the highest incidence rate (6.6 per million).
- Ninety percent of cases had at least one risk factor, and 77% presented with multiple symptoms. Computed tomography pulmonary angiography was the primary diagnostic tool (81%).
Conclusions:
- Pediatric PE is infrequent, with a notable higher risk observed in adolescent females.
- A high index of suspicion is warranted in children with risk factors, especially when other diagnoses are ruled out.
- Early recognition and intervention are critical for managing pediatric PE.
Background:
Pediatric pulmonary embolism (PE) is a rare event associated with significant morbidity and mortality. Awareness of clinical presentation and practices unique to children may aid clinicians in prompt identification and treatment.
Objectives:
To describe the incidence, risk factors, clinical presentation, diagnostic and therapeutic practices, and short-term outcomes of pediatric PE.
Methods:
We conducted a 3-year national surveillance study through the Canadian Pediatric Surveillance Program. Over 2800 pediatric specialists and subspecialists were contacted monthly from 2020 to 2022 and requested to report all new cases of PE in patients up to 18 years of age. Case-specific data were obtained through voluntary completion of a detailed questionnaire.
Results:
Fifty-eight cases (78% female, n = 45) were reported (2.4 cases per million children), with rates highest in adolescents 15 to 18 years (6.6 cases per million). Detailed information, available for 31 (53%) cases, documented at least 1 risk factor in 28 (90%) cases; 24 (77%) patients presented with 2 or more symptoms. Computed tomography pulmonary angiography was used for diagnostic confirmation in 25 (81%) cases. Anticoagulation was initiated in 24 (77%) of 31 cases; fewer than 5 patients underwent thrombolysis or surgical interventions. Of 28 patients who received therapeutic interventions, 8 (29%) experienced treatment-related complications. Fewer than 5 mortalities were reported.
Conclusion:
Pediatric PE is a rare event, with female adolescents at the highest risk. Although the presentation is often nonspecific, clinicians should maintain a high index of suspicion, particularly in patients with risk factors and when other diagnoses that may explain symptoms have been excluded.
