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Res Pract Thromb Haemost. 2019 Oct 26;4(1):124-130. doi: 10.1002/rth2.12265. eCollection 2020 Jan.

Clinical variables that increase the probability of pulmonary embolism diagnosis in symptomatic children.

Author information

1
Division of Pediatric Emergency Medicine Saint Louis Children's Hospital Washington University School of Medicine St Louis MO USA.
2
Division of Pediatric Emergency Medicine The Children's Hospital of Philadelphia Philadelphia PA USA.
3
Divisions of Emergency Medicine Department of Pediatrics Boston Children's Hospital Harvard Medical School Boston MA USA.
4
Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN USA.

Abstract

Background:

Pulmonary embolism (PE) in children carries a significant morbidity and mortality. We examined previously described factors in 2 cohorts of children tested for PE and identified novel factors.

Methods:

We combined data from 2 retrospective cohorts. Patients up to age 21 years were included who underwent imaging or D-dimer testing for PE, with positive radiologic testing being the gold standard. Combined predictor variables were examined by univariate analysis and then forward stepwise multivariable logistic regression.

Results:

The combined data set yielded 1103 patients with 42 unique predictor variables, and 93 PE-positive patients (8.4%), with a median age of 16 years. Univariate analysis retained 17 variables, and multivariable logistic regression found 9 significant variables with increased probability of PE diagnosis: age-adjusted tachycardia, tachypnea, hypoxia, unilateral limb swelling, trauma/surgery requiring hospitalization in previous 4 weeks, prior thromboembolism, cancer, anemia, and leukocytosis.

Conclusion:

This combined data set of children with suspected PE discovered factors that may contribute to a diagnosis of PE: hypoxia, unilateral limb swelling, trauma/surgery requiring hospitalization in previous 4 weeks, prior thromboembolism, and cancer, age-adjusted tachycardia, tachypnea, anemia, and leukocytosis. Prospective testing is needed to determine which criteria should be used to initiate diagnostic testing for PE in children.

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