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Management of pulmonary thromboembolism in children: an evidence-based expert consensus
Li-Nan Zeng1,2,3,4, Ying-Xue Zou5, Hai-Lin Zhang6
1Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province, Chengdu, China.
Insights
Guidelines for pediatric pulmonary thromboembolism (PTE) are lacking. This expert consensus provides recommendations for diagnosis and management of PTE in children, addressing critical care needs.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular medicine
- Hematology
Background:
- Pulmonary thromboembolism (PTE) is a rare but life-threatening condition in children.
- Standardized diagnostic and management guidelines for pediatric PTE are currently unavailable.
- This expert consensus addresses the need for evidence-based recommendations for pediatric PTE.
Purpose of the Study:
- To develop expert recommendations for the diagnosis and management of pulmonary thromboembolism in children.
- To provide a standardized approach based on the best available evidence.
Main Methods:
- Utilized the World Health Organization Handbook for Guideline Development.
- A 30-member expert panel conducted systematic reviews and utilized the GRADE approach for evidence evaluation.
- Recommendations were developed using the GRADE Evidence to Decision Framework.
Main Results:
- 33 recommendations were formulated for 20 clinical questions concerning pediatric PTE.
- Recommendations cover diagnosis, anticoagulant therapy, thrombolysis, interventional procedures, and multidisciplinary care.
- 18 weak recommendations (low-quality evidence) and 15 good practice statements were established.
Conclusions:
- Expert recommendations for pediatric PTE management are provided, acknowledging generally low-quality and limited evidence.
- Further research is urgently needed for early identification, diagnosis, prevention, treatment, and long-term management strategies.
- The consensus aims to improve outcomes for children with pulmonary thromboembolism.
Background:
Pulmonary thromboembolism is rare in children, but can be life-threatening. Timely diagnosis and treatment of pulmonary thromboembolism are crucial for reducing mortality associated with pulmonary thromboembolism in children. While guidelines for pulmonary thromboembolism in adults are available, guidelines for standardized diagnosis and management of pulmonary thromboembolism in children are not. This expert consensus aims to provide recommendations for the management of pulmonary thromboembolism in children based on the current best available evidence.
Data Sources:
Following the World Health Organization Handbook for Guideline Development, the expert panel consisted of 30 members from different clinical areas. The panel identified clinical questions through systematic reviews and expert discussions, systematically reviewed evidence on pulmonary thromboembolism in children, and evaluated the quality of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Using the GRADE Evidence to Decision Framework, the panel made recommendations, considering the effects of interventions, resource use, values and preferences, equity, acceptability, and feasibility.
Results:
The epidemiology, classification, and pathophysiology characteristics are summarized. The expert panel developed 33 recommendations addressing 20 questions related to diagnosis steps, treatment approaches such as anticoagulant therapy, thrombolysis therapy, catheter-based interventional therapy, surgical embolectomy, multidisciplinary team, and treatment of patients with comorbidities, prognosis, education, as well as follow-up. Among these, 18 are weak recommendations based on very low quality evidence, and 15 are good practice statements.
Conclusions:
The expert panel provided recommendations for pulmonary thromboembolism in children based on available evidence, which was generally low in quality and volume. The panel urges further research on early identification and diagnosis strategies, preventive and therapeutic regimens, and long-term management for pulmonary thromboembolism.
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