Children with pulmonary embolism develop fewer long-term conditions than adults
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Key takeaways:
- Children developed post-pulmonary embolism syndrome at significantly lower rates than adults.
- Increased physical activity can improve aerobic abilities and dyspnea in children who had a pulmonary embolism.
Children who had a thromboembolic pulmonary embolism rarely developed post-PE syndrome, including high blood pressure in the lungs or cardiac or functional impairment, according to a study published in Blood.
A third of the children studied at The Hospital for Sick Children (SickKids) in Toronto, Canada, had a follow-up examination that revealed at least one abnormal lung condition, although most resolved over time with increased physical activity.
“The results showed an overall lower frequency of adverse functional outcomes for pediatric patients as compared with adults diagnosed with pulmonary embolism,” Laura Avila, MD, PhD, clinician scientist at SickKids, told Healio.
“Further, most abnormal findings were transient,” she added. “There are several potential explanations for the lower frequency of complications, including possibly better healing in younger patients — a point that requires further investigation.”
Background and methods
Documented pulmonary embolisms increased by 200% from 2001 to 2014 among children treated at pediatric tertiary institutions, based on background information provided by the study’s investigators.
Adults who had a PE develop post-PE syndrome roughly 50% of the time, but rates in children have not been researched at length.
“This knowledge is relevant for counseling and to develop measures to support rehabilitation and healthy living for these young patients, who may still have up to 6 to 8 decades of life ahead,” Avila said.
Researchers evaluated patients aged 18 years or younger who had a pulmonary embolism, survived at least 6 months and followed up at SickKids between 2004-2022 to determine the frequency of developing post-PE syndrome.
Children had clinical evaluations, chest imaging, echocardiograms, and pulmonary function and cardiopulmonary exercise testing 3 to 6 months after their PE to determine whether they had any post-PE abnormalities.
Results
The study cohort consisted of 150 children with a median age of 16 years old.
Most of the population had an underlying condition (61%), the most frequent being autoimmune diseases (22%) and cancer (13%).
PE did not resolve in 29% of patients, thrombosis recurred in 9% and 4.7% of the cohort died.
Of the post-PE syndrome outcomes, only one patient had chronic thromboembolic pulmonary hypertension (CTEPH), one had cardiac impairment, and 15% of tested children (15 of 59) had irregular exercise test results and dyspnea.
Among the more common abnormalities, 26% of children had dyspnea, 11% of children tested had irregular echocardiograms (4% chronic), and 31% tested had abnormal aerobic capacity, but 82% of that group could explain the results to lack of conditioning and leg fatigue.
“It is important to focus on promoting physical activity in children affected by this type of thrombotic event,” Avila said.
Children with underlying conditions had a significantly higher rate of PE recurrence (13% vs. 1.7%, P = .016), diffusing capacity for carbon monoxide and ventilatory impairment and abnormal aerobic capacity (P = .04).
“These patients may benefit from closer follow-up,” Avila said.
“We feel that our study is only a starting point,” she added. “Our results are helpful to provide some answers for patients and their families in terms of what could be expected after having a pulmonary embolism and, hopefully, the results can also help researchers focus their ongoing or upcoming projects on areas that need further investigation.”
For more information:
Laura Avila, MD, PhD, can be reached at laura.avila@sickkids.ca.
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