Clinical Criteria for Imaging in Children at Risk for Pulmonary Embolism

Pulmonary embolism (PE) is a rare but serious condition in children. Clinical guidelines for imaging a suspected pediatric PE in Pediatric Emergency Medicine (PEM) are lacking. The computerized tomography pulmonary angiogram (CTPA) is the preferred diagnostic modality for suspected PE in an emergency department. Our study aims to introduce a simplified clinical assessment tool for ordering CTPA in children in the emergency room. This is a retrospective review of patients managed in our Emergency Department from 2000 to 2020. Patients were identified using International Classification of Diseases codes for PE, deep vein thrombosis, or similar diagnoses. The control group consisted of patients with PE symptoms, seen within the same time frame as the study group, who had negative CTPA. Twenty-five CTPA-positive patients were identified. Twenty-three of 25 CTPA-positive patients were aged 13 to 18 years. Common risk factors include protein-losing state (ie, nephrotic syndrome), oral contraceptive pill use, and obesity. Chest pain and tachypnea were the most common complaint and clinical sign, respectively. The hypercoagulability screen was negative in 65% of the patients. The mean D-dimer was 5.27 g/mL, and 6 patients, of whom 4 had saddle PE, had D-dimer > 10. Recurrence of PE and neurologic deficits were noted in 2 patients each. We present clinical criteria for ordering CTPA in children with suspected PE based on data from our center and a literature review of pediatric studies. Further multicenter studies with larger samples are needed to validate our proposed criteria.