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Multicenter Study
. 2018 Jun 26;2(12):1403-1408.
doi: 10.1182/bloodadvances.2017013292.

Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

Shannon L Carpenter  1 , Troy Richardson  2 , Matt Hall  2
Affiliations
Multicenter Study

Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

Shannon L Carpenter et al. Blood Adv. .

Abstract

Although rare in children, pulmonary embolism (PE) can cause significant morbidity and mortality. Overall rates of venous thromboembolism (VTE) are increasing in hospitalized children. By using the Pediatric Health Information System database, we evaluated incidence, treatment, and outcome of PE in children younger than age 18 years from 2001 to 2014. Demographic characteristics for those admitted with VTE alone and those admitted with PE were compared. Rates of PE by year were compared with the number of hospital and VTE admissions. Trends in medication use were analyzed. Over the period of the study, patients with PE made up 15.8% of VTE discharges. The overall rate of PE increased 200% (P < .001). Compared with all other age groups, adolescents (age 13-18 years) had the highest prevalence (55%; P < .001), the rate of which increased from 9.8 to 24.7 per 10 000 hospital discharges (152%; P < .001), and from 17.5 to 34.1 per 100 VTE discharges (95%; P < .001). Individuals with PE had a higher mortality (8.3% vs 6%; P < .001) and were less likely to have a complex chronic condition (58% vs 65%; P < .001) than those with VTE alone. However, PE mortality rates decreased over the time period studied. African American and Hispanic patients were more likely to experience recurrent PE than white patients (12% and 10.7% vs 8%; P = .002). During the study period, the use of unfractionated heparin decreased (P < .001), and the use of low molecular weight heparin increased (P < .001). Further research is required to determine what factors contribute to the higher rate of PE in adolescents and influence recurrence in African American and Hispanic patients.

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Conflict of interest statement

Conflict-of-interest disclosure: S.L.C. received honoraria from Bayer, CSL Behring, HEMA Biologics, and Novo Nordisk for consulting services and serves on a study steering committee for Genentech and on an advisory board for Kedrion. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Rate of PEs per 10 000 discharges and 100 VTE admissions. Error bars indicate standard deviation.
Figure 2.
Figure 2.
Mortality over time of PE vs VTE. Error bars indicate standard deviation.
Figure 3.
Figure 3.
Top non-PE associated diagnoses associated with PEs. HB-S, hemoglobin S; LE, lower extremity; MRSA, methicillin-resistant S aureus; MSSA, methicillin-sensitive S aureus.
Figure 4.
Figure 4.
Initial use of anticoagulants in patients with PEs. P values represent change in anticoagulant use over time. Error bars indicate standard deviation. tPA, tissue plasminogen activator.
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