A large national study examined the epidemiology, risk factors, and outcomes associated with acute pulmonary embolism in U.S. children and adolescents.
In the study, published in The Lancet Respiratory Medicine, investigators drew on nationwide hospital discharge data from 2016 to 2021. They conducted a retrospective cohort analysis using data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), which included more than 120,000 pediatric hospitalizations involving primary or secondary pulmonary embolism (PE) diagnoses. This diverse cohort consisted of patients under 18 years of age, enabling a comprehensive analysis across different age groups, sexes, races, and comorbidities. The study employed logistic regression models to assess associations between patient characteristics and PE outcomes, adjusting for factors such as hospital region, teaching status, and insurance type. The investigators also performed survival analyses to determine mortality risk factors, with adjusted odds ratios (OR) provided alongside 95% confidence intervals (CI).
The investigators revealed that although pediatric PE is rare, it poses significant morbidity and mortality risks, particularly among high-risk subgroups. They indicated that the incidence of pediatric PE was 5.4 cases per 100,000 hospitalizations, with the highest rates observed among adolescents aged 15 to 17 years. In-hospital mortality among pediatric patients with PE stood at 6.1%, with neonates and pediatric patients with chronic conditions experiencing the highest mortality rates. Key comorbidities linked to elevated PE risk included cancer, congenital heart disease, obesity, and recent surgery, with cancer showing an adjusted OR of 3.52.
Additionally, factors such as venous thromboembolism (VTE) history, prolonged immobilization, and central venous catheter use significantly increased PE incidence. Notably, racial disparities were evident, with Black and Hispanic patients experiencing higher PE-related mortality compared with non-Hispanic White patients. Black patients, for instance, had an adjusted OR of 1.25 for PE-related mortality, highlighting the influence of race on outcomes.
"In this context, acute [PE] is a rare cause of death among children and adolescents, but might occur in concomitance and represent a marker of the severity of other conditions," said lead study author Simon Wolf, MMed, of the Department of Angiology at the University Hospital Zurich, and his colleagues.
The study emphasized the need for pediatric-specific clinical guidelines to enhance PE management and treatment outcomes. The investigators also advocated for prospective multicenter studies to explore the underlying pathophysiologic mechanisms of pediatric PE and evaluate the efficacy of novel anticoagulant therapies.
Further research into the social determinants of health contributing to racial disparities was recommended, aiming to develop personalized and equitable care strategies for pediatric patients at risk of PE.
The study disclosed no conflicts of interest, with all analyses conducted in adherence to ethical research standards and appropriate institutional approvals secured for the use of hospital discharge data.
