Acute pulmonary embolism in children and adolescents in the USA (2016 and 2019): a nationwide retrospective cohort study
Simon Wolf, Luca Valerio, Nils Kucher, Stavros Konstantinides, Irene L M Klaassen, C. Heleen van Ommen, Cihan Ay, Frederikus A. Klok, Suzanne C Cannegieter, Stefano Barco
Abstract
BACKGROUND: Epidemiological data on acute pulmonary embolism among children and adolescents are sparse and only date back to the 2000s. We aimed to establish annual estimates and age-stratified and sex-stratified indicators of acute pulmonary embolism among children and adolescents aged 0-19 years. METHODS: We did a retrospective, nationwide, patient-level analysis of the Kids' Inpatient Database, including 5733 patients with acute pulmonary embolism aged 0-19 years admitted to hospital in the USA in 2016 and 2019. The database includes data of all children admitted to hospital during the 2 years available. We also accessed the US Multiple Cause of Death database and population data from the US Census Bureau for the same 2 years. We estimated the incidence, mortality, case fatality, and proportional mortality rates, provided data on the annual pulmonary embolism burden, and provided data on clinical events recorded during hospitalisation. FINDINGS: In the years 2016 and 2019, 5733 patients (3353 [58.5%] female and 2380 [41.5%] male) were admitted to hospital with acute pulmonary embolism as the primary diagnosis or a concomitant diagnosis. The annual incidence of acute pulmonary embolism was 3·5 (95% CI 3·4-3·6) per 100 000 people. Two peaks in the incidence rate were observed-one in infants younger than 1 year and one in adolescents aged 15-19 years. The in-hospital case fatality rate was 4·5% (4·0-5·1). The crude odds ratio for in-hospital death among patients with (vs without) acute pulmonary embolism was 9·3 (7·9-10·9). The association between acute pulmonary embolism and death persisted across different multivariable models. Patients with acute pulmonary embolism with high-risk (vs no high-risk) features had the highest risk of death: 25·3% (20·6-30·5) among patients aged 0-9 years and 13·9% (11·9-16·2) among patients aged 10-19 years. In patients without high-risk features, risk of death was 4·9% (3·1-7·6) among patients aged 0-9 years and 0·7% (0·5-1·0) among patients aged 10-19 years. The risk of intracranial bleeding was also highest in the presence of pulmonary embolism with high-risk features: 8·1% (5·5-11·7) among patients aged 0-9 years and 3·6% (2·6-4·9) among patients aged 10-19 years. In patients without high-risk features, the risk of intracranial bleeding was 2·5% (1·3-4·6) among those aged 0-9 years and 0·5% (0·3-0·8) in those aged 10-19 years. Reperfusion treatments beyond systemic thrombolysis were rarely used among children and adolescents with acute pulmonary embolism. INTERPRETATION: Acute pulmonary embolism is rare during childhood and adolescence. The high pulmonary embolism-related fatality among specific subgroups of patients can be interpreted in the context of severe comorbidities and pulmonary embolism events with high-risk features. FUNDING: None.