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Epidemiological characteristics of pulmonary thromboembolism in children: a systematic review and meta-analysis
Jianing Liu1,2,3,4,5, Xiaofeng Ni1,2,3,4,6, Linan Zeng1,2,3,6
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
Pediatric pulmonary thromboembolism (PTE) is rare but increasing, with significant recurrence and fatality rates. Further research is needed to refine estimates and inform prevention and management strategies for this condition.
Area of Science:
- Pediatric Medicine
- Cardiovascular Research
- Epidemiology
Background:
- Pulmonary thromboembolism (PTE) is a rare but life-threatening condition in children.
- Pediatric PTE differs significantly from adult PTE in epidemiology and risk factors.
- Understanding these differences is crucial for effective diagnosis and treatment.
Purpose of the Study:
- To conduct a systematic review and meta-analysis on the epidemiology, clinical characteristics, and risk factors of pediatric PTE.
- To summarize current knowledge and identify trends in pediatric PTE.
- To inform future research and clinical practice.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Searched eight databases for studies on pediatric PTE.
- Included original studies reporting epidemiology, clinical characteristics, or risk factors; excluded reviews and case reports without epidemiological data.
Main Results:
- 26 studies included, mostly of high quality.
- Pooled incidence of pediatric PTE was 0.016%; autopsy-confirmed prevalence was 5.29%.
- Case fatality was 4.04%, recurrence was 26.31%, with an increasing trend observed.
Conclusions:
- Pediatric PTE is uncommon but increasing, with significant recurrence and fatality.
- Further high-quality, population-based studies are needed to refine epidemiological estimates.
- Clarifying age-specific risk profiles is essential for prevention and management.
Objectives:
Pulmonary thromboembolism (PTE) is rare but potentially life-threatening in children and differs substantially from adult PTE in epidemiology and risk factors. We conducted a systematic review and meta-analysis to summarise the epidemiology, clinical characteristics and risk factors of paediatric PTE.
Design:
A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Data Sources:
We searched eight databases (PubMed, Embase (Ovid), MEDLINE (Ovid), Cochrane Library and four Chinese databases) on 2 March 2023, with an updated search on 2 July 2024.
Eligibility Criteria:
We included original studies reporting epidemiology (incidence/prevalence, major clinical outcomes and long-term sequelae), clinical characteristics, or risk factors of PTE in patients younger than 18 years. Reviews, case reports/series without extractable epidemiological data and studies not focused on paediatric PTE were excluded.
Data Extraction And Synthesis:
Two reviewers independently screened studies, extracted data and assessed risk of bias using appropriate tools for observational studies. A random-effects model was applied to pool prevalence and incidence estimates, along with related outcomes, and their 95% CIs, regardless of the degree of heterogeneity.
Results:
From 14 438 records, 26 studies were included: 16 cross-sectional, 9 cohort and 1 case-control study. 23 studies were marked as high quality and three as moderate quality. The pooled incidence of paediatric PTE was 0.016% (95% CI 0.0011% to 0.0298%). Autopsy-confirmed prevalence was 5.29% (95% CI 1.28% to 9.30%). Case fatality was 4.04% (95% CI 0.49% to 7.58%), and recurrence was 26.31% (95% CI 19.62% to 33.01%). Available evidence suggested an increasing trend in PTE occurrence over recent years. Female sex and oral contraceptive use were frequently reported clinical characteristics in adolescents. Reported risk factors clustered into genetic predisposition, underlying diseases, immobilisation or surgery and central venous catheter-related thrombosis.
Conclusions:
Paediatric PTE remains uncommon but appears to be increasing, with notable recurrence and non-negligible fatality. Given heterogeneous study settings and definitions, further high-quality, population-based studies are needed to refine epidemiological estimates and clarify age-specific risk profiles, thereby informing prevention strategies and clinical management.
Trial Registration Number:
PREPARE-2023CN922.
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