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Observational Study
. 2025 Dec 1;26(12):e1501-e1509.
doi: 10.1097/PCC.0000000000003841. Epub 2025 Oct 17.

Development, Implementation, and Evaluation of a Pediatric Pulmonary Embolism Clinical Pathway and Pulmonary Embolism Response Team

Hilary B Whitworth  1   2 , Kristina M Wagner  1   3   4 , Catherine M Avitabile  2   5 , Bridget Blowey  6 , Rose A Costello  7 , J Christopher Davis  8 , Daniela H Davis  4 , Angela M Ellison  9 , Therese M Giglia  5 , Adam S Himebauch  4 , Katherine Houng  10 , Connie K Law  6 , Constantine D Mavroudis  11 , Laura Mercer-Rosa  5 , Michael L O'Byrne  2   5 , Chitra Ravishankar  5 , Leslie J Raffini  1
Affiliations
Observational Study

Development, Implementation, and Evaluation of a Pediatric Pulmonary Embolism Clinical Pathway and Pulmonary Embolism Response Team

Hilary B Whitworth et al. Pediatr Crit Care Med. .

Abstract

Objectives: U.S. multicenter pediatric data from 2001 to 2014 indicate that the prevalence of pediatric pulmonary embolism (PE) is rising, yet it remains rare at individual centers. Evaluation and management vary due to the low frequency of events. And, therefore, we aimed to develop, implement, and evaluate a clinical management pathway and PE response team (PERT) at our center.

Design: Single-center observational implementation study with pre- vs. post-implementation comparisons.

Setting: Quaternary care pediatric hospital.

Patients: Pediatric patients younger than 21 years old with acute PE who presented for care between January 2005 and August 2022 (pre-implementation) and between September 2022 and August 2024 (post-implementation).

Interventions: Implementation of a PE clinical pathway and PERT.

Measurements and main results: A PE clinical pathway and PERT were developed by a multidisciplinary team of pharmacists, quality improvement experts, and physicians from six clinical specialties. Electronic medical record tools were created to support the implementation of this pathway and PERT, and research and quality databases were created for ongoing evaluation. PE evaluation was standardized with the implementation of the PE clinical pathway. In the 23 months post-implementation, there have been 33 patients with acute PE (24 low-risk, seven intermediate-risk, and two high-risk PE), which we compared with our pre-pathway experience of 175 episodes. The proportion of patients who had laboratory testing with brain natriuretic peptide and troponin, or underwent echocardiogram during their admission increased, pre-vs.-post-implementation, respectively (50/175 vs. 30/33; p < 0.01; 55/175 vs. 30/33; p < 0.01; and 142/175 vs. 32/33; p < 0.02). The multidisciplinary PERT was successfully activated for seven patients with intermediate- or high-risk PE.

Conclusions: Implementation of a pediatric PE clinical pathway and PERT improved standardization of PE evaluation and provided rapid multidisciplinary care for intermediate and high-risk PE. Future reports will evaluate both short- and long-term clinical outcomes in these patients.

Keywords: critical care; critical pathways; pediatrics; pulmonary embolism; quality improvement.

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Conflict of interest statement

Dr. Whitworth’s institution received funding from the National Hemophilia Foundation-Takeda Clinical Fellowship. Dr. Himebauch’s institution received funding from the National Heart, Lung, and Blood Institute (K23HL153479). All authors disclosed off-label use of interventional catheters, anticoagulants, and thrombolytic medications in children. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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    1. Rastogi R, Okunowo O, Faerber JA, et al.: Incidence, management, and outcomes of pulmonary embolism at tertiary pediatric hospitals in the United States. JACC Adv. 2024; 3:100895
    1. Rivera-Lebron BN, Rali PM, Tapson VF: The PERT concept: A step-by-step approach to managing pulmonary embolism. Chest. 2021; 159:347–355
    1. Rosovsky R, Zhao K, Sista A, et al.: Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost. 2019; 3:315–330
    1. Rosovsky R, Chang Y, Rosenfield K, et al.: Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis. J Thromb Thrombolysis. 2019; 47:31–40

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