The rare but formidable pediatric pulmonary embolism

A vast American study reveals that pediatric pulmonary embolism. For example, 30 times rarer than in adults, has a particular severity with a risk of death multiplied by 9, especially in adolescent girls.

Pulmonary embolism (EP) remains exceptional in children. Furthermore, adolescents, with an impact much lower than that of adults (estimated at 115 cases per 100,000 people in the United States). Meanwhile, Unlike adults, identifiable risk factors can be found in up to 95 % of children, including central venous catheters and hormonal contraception. However, pediatric epidemiology remains poorly documented: the latest US national data date from 2001-2007, reporting an incidence of 0.9 cases per 100,000 children and adolescents.

A retrospective analysis at the national level

Faced with this lack of recent data. For example, the diagnostic complexity of this pediatric pathology, S. Furthermore, Wolf et al. For example, present a retrospective study of cohort rare but formidable pediatric pulmonary conducted in the United States to update knowledge of the epidemiology. Nevertheless, the etiological context of the EP from birth to 19 years. The authors have exploited the database Kids’ Inpatient Databaselisting hospitalizations in the majority of American hospitals for patients aged 0 to 19. The analysis focused on the years 2016. 2019, with a collection of demographic data by age group (newborns, 1-4 years, 5-9 years, 10-14 years and 15-19 years), risk factors, mortality and events occurring during hospitalization.

A rare but serious event

In 2016 and 2019, 5,733 young patients were hospitalized with an EP as main or concomitant diagnosis (including 58.5 % of girls). The extrapolated impact to the general population reaches 3.5 cases per 100,000 subjects (95 % trust interval [IC95] : 3.4 to 3.6), more than 30 times lower than the estimate in adults.

The age distribution follows a J curve with two separate peaks: a first, rare but formidable pediatric pulmonary modest, before the age of 1 year (3.2 cases / 100,000 [2,8 à 3,6]), or 246 cases (4.3 % of the cohort), without difference according to sex, and a second net peak between 15 and 19 years (10.4 cases / 100,000 [10,1 à 10,7]), or 4,392 cases (76.6 % of the cohort) with a clear female predominance (62 % of young girls). Additionally, The overall hospital mortality rate was 4.5 %.

Unlike adults, the pediatric EP occurs mainly in the presence of identifiable risk factors. Invasive resuscitation represents the most common context: 44.5 % of cases between 0-9 years and 19.3 % between 10 and 19 years old. The presence of a risk factor clearly aggravates the prognosis of the EP. Hospital mortality according to age and the presence of risk factors reached:

• Between 0 and 9 years old: 25.3 % against 4.9 % in the absence of a risk rare but formidable pediatric pulmonary factor
• Between 10 and 19 years old: 13.9 % against 0.7 %.

In addition. compared to the adult, the EP of the child and the adolescent presents, in itself, a particular intrinsic gravity. The gross risk of death is multiplied by 9.3 in unresolved analysis, and remains significant after adjustment (RR = 2.5 [2,0 à 3,2]).

In 10-19 year olds, multivariate analysis identifies several comorbidities significantly associated with death: sepsis (p = 0.025), hematological cancers (p <0.001), heart failure (p <0.001), cerebrovascular (p <0.001) diseases, respiratory (p <0.001) and renal insufficiency (p = 0.002).

To explain the female predominance observed between 15. 19 years old, the authors evoke the maturation of the hemostatic system, the increase in pubertal estrogen levels and the use of oral contraceptives, although the methodology does not allow these factors precisely.

The authors conclude that pulmonary embolism is a rare event in childhood. adolescence, of much lower incidence than rare but formidable pediatric pulmonary in adults. The prognosis is severe in certain patient subgroups. due to comorbidities, but also due to the proper gravity of the embolic event.