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Pulmonary embolism in pediatric age: a retrospective study from a tertiary Centre
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  • Raquel Lopes de Braganca,
  • Vanessa Gorito,
  • Diana Cibele,
  • Luciana Gonçalves,
  • Augusto Ribeiro,
  • Maria João Baptista,
  • Inês Azevedo
Raquel Lopes de Braganca
Centro Hospitalar Universitario de Sao Joao
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Vanessa Gorito
Centro Hospitalar Universitário de São João
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Diana Cibele
Centro Hospitalar Universitario de Sao Joao
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Luciana Gonçalves
Centro Hospitalar Universitario de Sao Joao
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Augusto Ribeiro
Centro Hospitalar Universitario de Sao Joao
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Maria João Baptista
Centro Hospitalar Universitario de Sao Joao
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Inês Azevedo
Centro Hospitalar Universitário de São João
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Abstract

Introduction: Pediatric pulmonary embolism (PE) is rare but associated with adverse outcomes. We aimed to characterize PE cases admitted in a tertiary hospital and to evaluate sensitivity of PE diagnostic prediction tools. Methods: Retrospective, descriptive study of PE cases admitted from 2008 to 2020. Data was collected from hospital records. Patients were grouped according to PE severity and setting (outpatients, inpatients). Associations with demographic characteristics, risk factors, clinical presentation, management and outcomes were analyzed. PE diagnostic prediction tools were applied. Results: 29 PE episodes occurred in 27 patients, 62.9% female, mean age 14.1 years. Most PE were central and massive or submassive. One was diagnosed in autopsy. Outpatients (n=20), admitted for classic PE symptoms, were adolescents; in half the diagnosis had been missed previously. Risk factors included contraceptives (65%), thrombophilia (35%), obesity (20%) and auto-immunity (20%). Inpatients´ PE (n=8), diagnosed during cardiorespiratory deterioration (n=5) or through incidental radiological findings (n=3), were younger and had immobilization (87.5%), complex chronic diseases (75%), infections (75%) and central venous catheter (62.5%) as risk factors. Retrospectively, D-dimer testing and adults’ scores performed better than pediatrics’ scores (sensitivity 92.9-96% vs 85.7- 92.9%). Both pediatrics’ scores missed a case with a positive family history. Discussion: Pediatric PE diagnosis is often delayed or missed. To improve it, the development of pediatric prediction tools as from validated adult scores merits to be explored. We propose that clinical presentation and risk factors may be different in inpatients and outpatients. Family history should be included.

Peer review status:ACCEPTED

22 Jan 2021Submitted to Pediatric Pulmonology
23 Jan 2021Submission Checks Completed
23 Jan 2021Assigned to Editor
24 Jan 2021Reviewer(s) Assigned
02 Mar 2021Review(s) Completed, Editorial Evaluation Pending
04 Mar 2021Editorial Decision: Revise Major
19 Mar 20211st Revision Received
22 Mar 2021Submission Checks Completed
22 Mar 2021Assigned to Editor
22 Mar 2021Reviewer(s) Assigned
13 Apr 2021Review(s) Completed, Editorial Evaluation Pending
18 Apr 2021Editorial Decision: Revise Minor
18 May 20212nd Revision Received
19 May 2021Assigned to Editor
19 May 2021Reviewer(s) Assigned
19 May 2021Submission Checks Completed
21 May 2021Review(s) Completed, Editorial Evaluation Pending
21 May 2021Editorial Decision: Accept