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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

Division of Medical Critical Care, Department of Pediatrics, and
Harvard Medical School, Harvard University, Boston, Massachusetts.
Center for Resuscitation Science, Boston, Massachusetts; and.
Departments of Medicine and.
Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Division of Pulmonary and Critical Care Medicine.
Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.



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


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.


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).


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.


Conflict of interest statement

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

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