Incidence rate of PE-related hospitalizations low in pediatric population

Key takeaways:

• Per 100,000 people, researchers reported fewer than four PE-related hospitalizations in patients aged zero to 19 years.
• Incidence rate and in-hospital case fatality rate differed by age and sex.

The incidence rate of pulmonary embolism-related hospitalizations in pediatric patients revealed that this outcome occurred infrequently; however, having acute PE raised the odds for in-hospital mortality, according to study findings.

“Acute PE is rare but has a high risk of in-hospital death,” Simon Wolf, MMed, research assistant at University Hospital Zurich and PhD candidate at Leiden University Medical Center, told Healio.

“Early recognition and adequate treatment are necessary to mitigate the impact of the disease, and if acute PE is severe, reperfusion treatments should be considered, as it is the case in adults,” Wolf said. “Moreover, PE might represent a marker for the severity of other conditions, so careful management of these patients is indicated.”

Using 2016 and 2019 data from the Kids’ Inpatient Database, the U.S. Multiple Cause of Death database and U.S. Census Bureau population data, Wolf and colleagues conducted a nationwide retrospective cohort study and evaluated 5,733 patients (median age, 17 years; 58.5% female) aged zero to 19 years admitted to a hospital for/with acute PE to determine various rates in this population (incidence, mortality, case fatality) and how these rates differ by age and sex.

This study was published in The Lancet Respiratory Medicine.

Per 100,000 people, researchers reported a low number of PE-related hospitalizations (3.5), signaling that this type of hospitalization is rare. When divided by age, patients aged younger than 1 year and patients aged 15 to 19 years had elevated incidence rates of 3.2 per 100,000 people (males, 3.5; females, 2.8) and 10.4 per 100,000 people (males, 7.7; females, 13.3), respectively.

The study also noted a low number of PE-related in-hospital deaths (0.16 per 100,000 people), and when split by age, those aged younger than 1 year had a heightened rate (0.7 per 100,000 people).

Switching to in-hospital case fatality, 4.5% was the observed rate, according to the study. Compared with patients aged 15 to 19 years, patients aged younger than 1 year had a greater in-hospital case fatality rate (23.4% vs. 3%). Dividing each age group by sex revealed an elevated rate in females vs. males in the younger than 1 year group (33% vs. 15.9%) and a lower rate in females vs. males in the 15- to 19-year-old group (2.1% vs. 4.5%).

Between hospitalized patients with acute PE and hospitalized patients without acute PE, researchers found that the acute PE group had increased odds for in-hospital mortality in an unadjusted model (OR = 9.3; 95% CI, 7.9-10.9), an age- and sex-adjusted model (adjusted OR = 13.2; 95% CI, 11.3-15.5) and an age-, sex- and comorbidity-adjusted model (aOR = 2.5; 95% CI, 2-3.2).

“We have shown that hospitalized kids with acute PE have a higher risk of dying compared to patients without PE,” Wolf told Healio. “This association was maintained after correction for several severe comorbidities, age and sex, indicating that the severity of acute PE would likely play a role. This confirms among children evidence from adults and elderly.”

Within the cohort of patients with acute PE, 1,273 (n = 297 aged 0-9; n = 978 aged 10-19) had high-risk features, whereas the remainder did not have these features. According to the study, some notable high-risk features included the need for invasive ventilation, cardiac arrest, cardiopulmonary resuscitation, need for veno-arterial extracorporeal membrane oxygenation and the need for systemic thrombolysis.

The case fatality rate was impacted by the presence of high-risk features, and 0- to 9-year-olds with these features had a greater rate than 10- to 19-year-olds (25.3% vs. 13.9%), according to the study.

Researchers observed a similar pattern among those who did not have high-risk features, with a higher case fatality rate among 0- to 9-year-olds vs. 10- to 19-year-olds (4.9% vs. 0.7%).

In the younger age range group, the study noted an increased risk for intracranial bleeding in patients with vs. without high-risk features (8.1% vs. 2.5%). This was also true in the older age range group (with high-risk features, 3.6% vs. without high-risk features, 0.5%).

When evaluating conditions besides PE in this pediatric population, researchers found that around half had an endocrine disorder (52.6%) or cardiovascular disease (47.6%) in addition to PE. Further, more than one-third (40.4%) had a respiratory disease alongside PE.

Considering all pediatric patients with PE in this study, this group had three comorbidities more often than patients without PE: venous thromboembolic events other than deep vein thrombosis (absolute prevalence difference [APD] = 31.8%), metabolic disorders (APD = 15.2%) and obesity (APD = 14.7%).

“Concerning comorbidities, we found partly unexpected associations,” Wolf told Healio. “[That is] it seems that obese teenagers may get more acute PE than patients without obesity.”

When divided by sex, researchers observed that more females with PE had obesity, systemic lupus erythematosus and osteomyelitis compared with males, whereas more males with PE had sepsis, multiorgan failure and neoplasms compared with females.

“Patients with acute PE appeared to have a higher prevalence of several inflammatory, infectious and endocrinological conditions, with large sex-specific differences,” Wolf told Healio.

“More data on the impact of PE in children and adolescents are needed,” Wolf said. “Firm evidence is lacking concerning risk stratification, pharmacological therapies and reperfusion strategies. Further, our results call for the development of age-sex-specific prediction models for PE occurrence and PE-related death.”

For more information:

Simon Wolf, MMed, can be reached at simon.wolf@usz.ch.