Format

Send to

Choose Destination
Hosp Pediatr. 2020 Feb 11. pii: hpeds.2019-0290. doi: 10.1542/hpeds.2019-0290. [Epub ahead of print]

Pediatric Massive and Submassive Pulmonary Embolism: A Single-Center Experience.

Ross CE1,2,3, Shih JA2,4, Kleinman ME5,2, Donnino MW2,3,6,7.

Author information

1
Division of Medical Critical Care, Department of Pediatrics, and catherine.ross@childrens.harvard.edu.
2
Harvard Medical School, Harvard University, Boston, Massachusetts.
3
Center for Resuscitation Science, Boston, Massachusetts; and.
4
Departments of Medicine and.
5
Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
6
Division of Pulmonary and Critical Care Medicine.
7
Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Abstract

OBJECTIVES:

To describe and compare patient and event characteristics and outcomes in pediatric massive pulmonary embolism (MPE) and submassive pulmonary embolism (SMPE).

METHODS:

A retrospective cohort study at a quaternary-care pediatric hospital was conducted. Patients age <19 years with MPE (acute pulmonary embolism [PE] with cardiac arrest, hypotension, or compensated shock due to PE) or SMPE (right ventricular strain due to acute PE) between January 1997 and June 2019 were included.

RESULTS:

Thirty-three patients were identified, including 9 (27%) patients with MPE and 24 (73%) patients with SMPE. The most commonly identified risk factor was use of oral contraceptive pills in 16 (49%) patients. Six (18%) patients died, 3 (9%) of which were PE-related deaths. Before PE, patients with MPE were more likely to be hospitalized (89% vs 13%, P < .001), have major comorbidities (89% vs 25%, P = .002), central venous catheters (67% vs 17%, P = .01), critical illness (56% vs 8%, P = .009), immobility (67% vs 13%, P = .005), and be postoperative (44% vs 4%, P = .01). MPE patients were also more likely to die before discharge (56% vs 4%, P = .003). Both groups were equally likely to have primary reperfusion attempts (78% of MPE versus 67% of SMPE, P = .69).

CONCLUSIONS:

Pediatric MPE and SMPE differed in presentation, comorbidities, and risk factors, many of which were associated with hospitalization status. Pediatric-specific studies are warranted to determine risk assessment and management strategies, which may differ from adult guidelines.

PMID:
32047028
DOI:
10.1542/hpeds.2019-0290

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center