Charlie Yue Wang1, Vera Ignjatovic2, Peter Francis3, Timothy Cain4, Franz Babl5, Remi Kowalski6, Andrew Cochrane7, Paul Monagle8. 1. Department of Surgery, Monash University, Clayton, Victoria 3168, Australia; School of Clinical Sciences, Monash Health, Clayton, Victoria 3168, Australia. Electronic address: cywan14@student.monash.edu. 2. Haematology Research Group, Murdoch Children's Research Institute, Clayton, Victoria 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria 3052, Australia. Electronic address: verai@unimelb.edu.au. 3. Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: peter.francis@rch.org.au. 4. Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: tim.cain@rch.org.au. 5. The Cardiology Department, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: franz.babl@rch.org.au. 6. Department of Medical Imaging, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: remi.kowalski@rch.org.au. 7. Department of Surgery, Monash University, Clayton, Victoria 3168, Australia; Department of Cardiothoracic Surgery, Monash Health, Clayton, Victoria 3168, Australia. Electronic address: andrew.cochrane@monashhealth.org. 8. Haematology Research Group, Murdoch Children's Research Institute, Clayton, Victoria 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria 3052, Australia; Clinical Haematology Group, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: paul.monagle@rch.org.au.
Abstract
BACKGROUND AND AIMS: Current clinical decision rules for pulmonary embolism are based on adult populations and have not been validated in children. The objective was to identify and evaluate clinical features for a first lifetime episode of pulmonary embolism in children presenting to the emergency department. MATERIALS AND METHODS: We present a case-control study of children (≤18years) presenting to the emergency department of the Royal Children's Hospital, Melbourne between November 2007 and February 2015. Children with radiologically proven pulmonary embolism formed the case group, whilst children in whom there was a clinical suspicion of pulmonary embolism but negative diagnostic imaging formed the control group. Charts, electronic medical and imaging records of both cases and controls were reviewed and analysed. RESULTS: There were a total of 50 patients in this study (11 cases and 39 controls). Current or recent (within three months) use of the oral contraceptive pill was the most significant risk factor in our study (odds ratio 14.667, 95% confidence interval 3.001-71.678, P<0.001). Most other features failed to discriminate between cases and controls, although there was a trend towards increased heart rate in cases. CONCLUSIONS: Pulmonary embolism is perhaps the most common presenting spontaneous venous thromboembolism in the community and teenage girls on the oral contraceptive pill are most at-risk amongst children. The clinical signs and symptoms are often non-specific. Additional larger studies are required to determine the significance and magnitude of potential clinical predictors identified in this study. This may lead to derivation of a paediatric-specific pre-test probability tool.
BACKGROUND AND AIMS: Current clinical decision rules for pulmonary embolism are based on adult populations and have not been validated in children. The objective was to identify and evaluate clinical features for a first lifetime episode of pulmonary embolism in children presenting to the emergency department. MATERIALS AND METHODS: We present a case-control study of children (≤18years) presenting to the emergency department of the Royal Children's Hospital, Melbourne between November 2007 and February 2015. Children with radiologically proven pulmonary embolism formed the case group, whilst children in whom there was a clinical suspicion of pulmonary embolism but negative diagnostic imaging formed the control group. Charts, electronic medical and imaging records of both cases and controls were reviewed and analysed. RESULTS: There were a total of 50 patients in this study (11 cases and 39 controls). Current or recent (within three months) use of the oral contraceptive pill was the most significant risk factor in our study (odds ratio 14.667, 95% confidence interval 3.001-71.678, P<0.001). Most other features failed to discriminate between cases and controls, although there was a trend towards increased heart rate in cases. CONCLUSIONS:Pulmonary embolism is perhaps the most common presenting spontaneous venous thromboembolism in the community and teenage girls on the oral contraceptive pill are most at-risk amongst children. The clinical signs and symptoms are often non-specific. Additional larger studies are required to determine the significance and magnitude of potential clinical predictors identified in this study. This may lead to derivation of a paediatric-specific pre-test probability tool.