1
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Huerta CT, Ramsey WA, Rodriguez C, Parreco JP, Thorson CM, Sola JE, Perez EA. Uncovering Risk Factors and Outcomes of Pulmonary Embolism in a Nationwide Cohort of Hospitalized Children. Am Surg 2024; 90:998-1006. [PMID: 38059918 DOI: 10.1177/00031348231220590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
PURPOSE The incidence of pulmonary embolism (PE) in hospitalized children has increased in recent years. This study sought to characterize factors and outcomes associated with PE using a national pediatric cohort. METHODS The Nationwide Readmissions Database was queried (2016-2018) for patients (<18 years) with a diagnosis of PE. Index and prior hospitalizations (PHs) within 1 year were analyzed. A binary logistic regression utilizing 37 covariates (demographics, procedures, comorbidities, etc.) was constructed to examine a primary outcome of in-hospital mortality. RESULTS 3440 patients were identified (57% female) with the majority >12 years old (77%). One-third had a known deep vein thrombosis (69% lower and 31% upper extremity). Nineteen percent underwent central venous catheter (CVC) placement. Twenty-one percent had a PH within 1 year. Nine percent underwent an operation with the majority being cardiothoracic (5%). Overall mortality was 5%. Neurocranial surgery, cardiothoracic surgery, and CVC placement were associated with the highest odds of inpatient mortality after logistic regression. CONCLUSION Pediatric patients with PE have a high rate of PHs, CVC placement, and inpatient operations, which may be associated with higher mortality. This information can be utilized to improve screening measures and clinical suspicion for PE in hospitalized children.
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Affiliation(s)
- Carlos Theodore Huerta
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Walter A Ramsey
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Cindy Rodriguez
- Florida State University College of Medicine, Tallahassee, FL, USA
| | | | - Chad M Thorson
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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2
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Eyraud C, Cassibba J, Suzanne M, Suler J, Grangette E, Mortamet G, Corvol H. Unusual chest pain and dyspnea. Pediatr Pulmonol 2024. [PMID: 38651945 DOI: 10.1002/ppul.27010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Coralie Eyraud
- Paediatric Department, Grenoble-Alps University Hospital, Grenoble, France
| | - Julie Cassibba
- Paediatric Department, Grenoble-Alps University Hospital, Grenoble, France
| | - Marie Suzanne
- Paediatric Department, Grenoble-Alps University Hospital, Grenoble, France
| | - Justine Suler
- Paediatric Department, Grenoble-Alps University Hospital, Grenoble, France
| | - Eve Grangette
- Paediatric Imagery, Grenoble-Alps University Hospital, Grenoble, France
| | - Guillaume Mortamet
- Paediatric Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University Hospital, Grenoble, France
| | - Harriet Corvol
- Pediatric Pulmonology Department, Reference Center for Rare Respiratory Diseases, RespiRare, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Centre de recherche Saint Antoine (CRSA), Paris, France
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3
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Chopko A, Tian M, L'Huillier JC, Filipescu R, Yu J, Guo WA. Utility of intracranial pressure monitoring in patients with traumatic brain injuries: a propensity score matching analysis of TQIP data. Eur J Trauma Emerg Surg 2024; 50:173-184. [PMID: 36795136 DOI: 10.1007/s00068-023-02239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Intracranial pressure monitoring (ICPM) is central to traumatic brain injury (TBI) management, but its utility is controversial. METHODS The 2016-2017 TQIP database was queried for isolated TBI. Patients with ICPM [(ICPM (+)] were propensity-score matched (PSM) to those without ICPM [ICPM (-)] and divided into three age groups by years (< 18, 18-54, ≥ 55). RESULTS PSM yielded 2125 patients in each group. Patients aged < 18 years had a higher survival probability (p = 0.013) and decreased mortality (p = 0.016) in the ICPM (+) group. Complications were higher and LOS was longer in ICPM (+) patients aged 18-54 years and ≥ 55 years, but not in patients aged < 18 years. CONCLUSIONS ICPM (+) is associated with a survival benefit without an increase in complications in patents aged < 18 years. In patients aged ≥ 18 years, ICPM (+) is associated with more complications and longer LOS without a survival benefit.
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Affiliation(s)
- Ashley Chopko
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | - Mingmei Tian
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, Buffalo, NY, 14214, USA
| | - Joseph C L'Huillier
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, School of Public Health and Health Professions, University at Buffalo, 270 Farber Hall, Buffalo, NY, 14214, USA
| | - Radu Filipescu
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 818 Ellicott Street, Buffalo, NY, 14203, USA
| | - Jinhee Yu
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, Buffalo, NY, 14214, USA
| | - Weidun A Guo
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA.
- Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, USA.
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Ergenekon AP, Yilmaz Yegit C, Cenk M, Gulieva A, Kalyoncu M, Selcuk M, Dogru O, Erdem Eralp E, Gokdemir Y, Karakoc F, Karadag B. The utility of risk assessment tools for acute pulmonary embolism in children. Pediatr Pulmonol 2023; 58:55-60. [PMID: 36121121 DOI: 10.1002/ppul.26155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
UNLABELLED BACKGROUND AND AIM: Pulmonary embolism (PE) is a potentially life-threatening disease in children. The objective of the study is to evaluate the utility of adult-based pulmonary embolism rule-out criteria (PERC), Pediatric PE Model, and D-dimer in the diagnosis of PE in children. MATERIAL AND METHODS The study consisted of patients under 18 years of age who were consulted to the Pediatric Pulmonology Clinic for the evaluation of PE. Patients were divided into two groups based on the confirmation of PE. The group with the presence of PE (n = 20) consisted of children who were diagnosed with PE. The group with the absence of PE (n = 28) consisted of children with clinically suspected PE but negative diagnostic imaging. Adult validated clinical decision PERC rule and Pediatric PE Model were retrospectively applied to the patients. RESULTS In the study, PERC demonstrated a sensitivity of 60% and a specificity of 46% for the diagnosis of PE in children. When PE Model was evaluated for the children, it was found a 50% sensitivity and 75% specificity. Combining PE Model and PERC rule with D-dimer did not increase the specificity and sensitivity. Smoking was found to be relevant for PE in the childhood. Twenty-five percent of the patients had a genetic tendency for PE. All of the patients had an underlying disease as well. CONCLUSION None of the current risk assessment tools (PE Model, PERC, D-dimer) were found to be accurate in predicting PE. Further larger population studies are still required to develop a better diagnostic approach.
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Affiliation(s)
- Almala P Ergenekon
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Muruvvet Cenk
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Mine Kalyoncu
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Merve Selcuk
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Omer Dogru
- Division of Pediatric Hematology and Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
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Ibrahim W, Mushtaq F. Consideration of pulmonary thromboembolism in paediatric patients presenting to the emergency department with abdominal pain. BMJ Case Rep 2021; 14:14/5/e239175. [PMID: 33975833 PMCID: PMC8118077 DOI: 10.1136/bcr-2020-239175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Venous thromboembolism (VTE) is a recognised complication of lower limb trauma in adult patients and classically presents with cardiopulmonary symptoms. However, the risk of VTE and its presenting signs and symptoms are less well documented in the paediatric population. We report the case of a child who presented to our emergency department with abdominal pain 2 weeks after lower limb fracture, who was subsequently found to have a pulmonary thromboembolism (PTE). This case report highlights the importance of having a high index of suspicion for VTE in the paediatric population if there are predisposing risk factors and to consider PTE as a differential cause of abdominal pain. To the authors' knowledge, no case has been described in which a child presenting with abdominal pain was consequently found to have a pulmonary embolism.
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Affiliation(s)
- Wasyla Ibrahim
- Emergency Department, University Hospital Hairmyres, East Kilbride, UK
| | - Farhat Mushtaq
- Emergency Department, NHS Lanarkshire, East Kilbride, UK
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6
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Sheng CQ, Yang CF, Ao Y, Zhao ZY, Li YM. Mycoplasma pneumoniae pneumonia with pulmonary embolism: A study on pediatric cases in Jilin province of China. Exp Ther Med 2021; 21:201. [PMID: 33574906 PMCID: PMC7818525 DOI: 10.3892/etm.2021.9634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
Mycoplasma is one of the most common pathogens causing community-acquired pneumonia in pediatric patients. In recent years, the number of refractory or severe cases with drug resistance has been gradually increasing and cases that developed embolism after Mycoplasma pneumoniae (M. pneumoniae) infection have been reported. The present study retrospectively analyzed the clinical features, diagnosis and treatment of M. pneumoniae pneumonia (MPP) combined with pulmonary embolism (PE) in a series of 7 cases encountered between January 1st, 2016 to August 1st, 2019 at the Department of Pediatric Intensive Care Unit of The First Hospital of Jilin University (Changchun, China). Combined with relevant Chinese and international studies published during the last two decades, a comprehensive analysis was performed. All of the pediatric patients of the present study had fever, cough and dyspnea respiratory symptoms at onset and the disease progressed rapidly. Thereafter, PE was confirmed by a series of examinations. Pulmonary CT indicated patchy inflammations and significantly elevated D-dimer levels, accompanied by positive anticardiolipin antibodies. Furthermore, a filling defect in the pulmonary artery branch was observed on CT pulmonary angiography (CTPA) examination. In 2 cases, the condition was improved with anti-infection and anticoagulation treatment with low-molecular-weight heparin and warfarin, respectively, and the pulmonary embolism disappeared after 3-4 months. A total of 5 cases, who were not responsive to the drug treatment, underwent surgical resection. During the operation, the local tissues were determined to be infarcted and the pathological diagnosis was consistent with pulmonary infarction. Among the 5 cases, 2 died of Acute Respiratory Distress Syndrome at 3-8 days after the operation. The remaining patients underwent 6-12 months of follow-up and respiratory rehabilitation and their quality of life is now good. In conclusion, compared with healthy individuals, pediatric patients with critical MPP have an elevated risk of embolism. It is necessary to be vigilant regarding whether MMP is combined with PE and perform timely CTPA examination. Early detection, early treatment and surgical intervention (if necessary) may significantly reduce the risk of mortality and disability.
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Affiliation(s)
- Chu-Qiao Sheng
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Chun-Feng Yang
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yu Ao
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhi-Yue Zhao
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yu-Mei Li
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Jeong LE, Na JY, Huh J, Kang IS, Yang JH, Jun TG, Song JY. Echogenic Mass Lesion within the Main Pulmonary Artery in a Neonate. NEONATAL MEDICINE 2020. [DOI: 10.5385/nm.2020.27.2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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8
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Agrawal S, Shrivastava Y, Bolia R, Panda PK, Sharawat IK, Bhat NK. Pulmonary Embolism in Children: A Case Series. Indian J Crit Care Med 2020; 24:1272-1275. [PMID: 33446985 PMCID: PMC7775944 DOI: 10.5005/jp-journals-10071-23682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary embolism (PE) is a life-threatening event with a mortality of ~10%. It is relatively uncommon in children and literature regarding the condition is sparse. In adults, the classical clinical presentation is with pleuritic chest pain, hemoptysis, and dyspnea, whereas in children, the presentation is often nonspecific. Materials and methods Clinical features, risk factors, and outcome of children with PE presenting to our unit between December, 19 and March, 2020 were recorded. Results Four children [mean age: 10 (6–16) years, 3 females], all presenting with tachycardia and dyspnea were diagnosed with PE. Different risk factors such as deep vein thrombosis, nephrotic syndrome, softtissue infection, and infective endocarditis (IE) were identified in all patients. One child died while others responded to anticoagulation. Conclusion We aim to highlight the importance of timely recognition of PE in children with known risk factors for the same. Early recognition and timely treatment of PE are critical to save lives. How to cite this article Agrawal S, Shrivastava Y, Bolia R, Panda PK, Sharawat IK, Bhat NK. Pulmonary Embolism in Children: A Case Series. Indian J Crit Care Med 2020;24(12):1272–1275.
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Affiliation(s)
- Sonam Agrawal
- Department of Paediatrics, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Yash Shrivastava
- Department of Paediatrics, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Rishi Bolia
- Department of Paediatrics, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Prateek K Panda
- Department of Paediatrics, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Indar K Sharawat
- Department of Paediatrics, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Nowneet K Bhat
- Department of Paediatrics, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
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9
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Cambrea SC, Balasa AL, Arghir OC, Mihai CM. Fatal rare case of measles complicated by bilateral pulmonary embolism: a case report and short literature review. J Int Med Res 2019; 48:300060519894120. [PMID: 31889456 PMCID: PMC7645360 DOI: 10.1177/0300060519894120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Different endemic outbreaks of measles have been diagnosed worldwide during the last several years. Some have had severe and fatal complications, possibly because of decreasing vaccination rates. The present case report describes an unvaccinated boy aged 2 years 11 months who was diagnosed with severe measles complicated by pulmonary embolism (PE). Clinical examination revealed a maculopapular rash, hyperemic pharynx, Koplik’s spots, upper respiratory airway obstruction, and tachycardia with no meningeal signs of irritation. Laboratory investigations showed leukocytosis, anemia, normal liver enzyme levels, a moderately high C-reactive protein level (26 mg/L), a high erythrocyte sedimentation rate (65 mm/h), and immunoglobulin M positivity for measles. The patient was treated with antibiotic therapy (meropenem at 20 mg/kg every 8 hours) and supportive measures (anti-inflammatory drugs and intravenous rehydration). On the fourth day of hospitalization, the patient’s general condition became profoundly altered; although cardiorespiratory resuscitation maneuvers were initiated, the child died. Autopsy revealed bilateral pleural effusion with serous citrine fluid, acute purulent bronchopneumonia, bilateral hilar adenopathy, and bilateral PE. Additional research is needed to establish optimal care for pediatric patients with measles, especially when complicated by PE.
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Affiliation(s)
- Simona Claudia Cambrea
- Infectious Diseases Department, Faculty of Medicine, Ovidius University of Constanta, Romania
| | | | - Oana Cristina Arghir
- Pulmonology Department, Faculty of Medicine, Ovidius University of Constanta, Romania
| | - Cristina Maria Mihai
- Pediatry Department, Faculty of Medicine, Ovidius University of Constanta, Romania
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10
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Venous thromboembolism in childhood: where is Brazil after 20 years? Hematol Transfus Cell Ther 2019; 42:62-69. [PMID: 31582342 PMCID: PMC7031103 DOI: 10.1016/j.htct.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 10/11/2018] [Accepted: 01/31/2019] [Indexed: 12/12/2022] Open
Abstract
Due to the longer survival of critically ill children, venous thromboembolism is a problem which is becoming increasingly recognized in pediatric practice. In the last decades, several international studies have been published, shedding a light upon the epidemiology of this disease during childhood. These data show peculiarities in the clinical presentation and the significant morbidity and mortality. The new "epidemic of thrombosis" in pediatric hospitals points toward the urgent need for specific treatment and prevention protocols targeting this population. In Brazil, knowledge regarding this disease remains scarce. The lack of epidemiological data impacts both the clinical care and the design of specific public policies in the field. Thus, a national registry of pediatric venous thromboembolism is relevant to the proposal of an appropriate plan of action to create a qualified net of assistance. The improvement in educational initiatives related to the field of Pediatric Hemostasis is also very important. In this review, we have updated the epidemiological, clinical and therapeutic aspects of the disease, as well as the prevention strategies.
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11
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Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Áinle FN, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Respir J 2019; 54:13993003.01647-2019. [DOI: 10.1183/13993003.01647-2019] [Citation(s) in RCA: 509] [Impact Index Per Article: 101.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Sherrod BA, McClugage SG, Mortellaro VE, Aban IB, Rocque BG. Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients. J Pediatr Surg 2019; 54:631-639. [PMID: 30361075 PMCID: PMC6451662 DOI: 10.1016/j.jpedsurg.2018.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate venous thromboembolism (VTE) rates and risk factors following inpatient pediatric surgery. METHODS 153,220 inpatient pediatric surgical patients were selected from the 2012-2015 NSQIP-P database. Demographic and perioperative variables were documented. Primary outcome was VTE requiring treatment within 30 postoperative days. Secondary outcomes included length of stay (LOS) and 30-day mortality. Prediction models were generated using logistic regression. Mortality and time to VTE were assessed using Kaplan-Meier survival analysis. RESULTS 305 patients (0.20%) developed 296 venous thromboses and 12 pulmonary emboli (3 cooccurrences). Median time to VTE was 9 days. Most VTEs (81%) occurred predischarge. Subspecialties with highest VTE rates were cardiothoracic (0.72%) and general surgery (0.28%). No differences were seen for elective vs. urgent/emergent procedures (p = 0.106). All-cause mortality VTE patients was 1.2% vs. 0.2% in patients without VTE (p < 0.001). After stratifying by American Society of Anesthesiologists (ASA) class, no mortality differences remained when ASA < 3. Preoperative, postoperative, and total LOSs were longer for patients with VTE (p < 0.001 for each). ASA ≥ 3, preoperative sepsis, ventilator dependence, enteral/parenteral feeding, steroid use, preoperative blood transfusion, gastrointestinal disease, hematologic disorders, operative time, and age were independent predictors (C-statistic = 0.83). CONCLUSIONS Pediatric postsurgical patients have unique risk factors for developing VTE. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Brandon A Sherrod
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL.
| | - Samuel G McClugage
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL
| | - Vincent E Mortellaro
- Department of Surgery, Division of Pediatric Surgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL
| | - Inmaculada B Aban
- Department of Biostatistics, The University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - Brandon G Rocque
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL
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Abstract
Pulmonary embolism (PE) in the pediatric population is relatively rare when compared to adults; however, the incidence is increasing and accurate and timely diagnosis is critical. A high clinical index of suspicion is warranted as PE often goes unrecognized among children leading to misdiagnosis and potentially increased morbidity and mortality. Evidence-based guidelines for the diagnosis, management, and follow-up of children with PE are lacking and current practices are extrapolated from adult data. Treatment options include thrombolysis and anticoagulation with heparins and oral vitamin K antagonists, with newer direct oral anticoagulants currently in clinical trials. Long-term sequelae of PE, although studied in adults, are vastly unknown among children and adolescents. Additional research is needed in order to provide pediatric focused care for patients with acute PE.
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Affiliation(s)
- Ahmar Urooj Zaidi
- Division of Hematology Oncology, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, United States
| | - Kelley K Hutchins
- Division of Hematology Oncology, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, United States
| | - Madhvi Rajpurkar
- Division of Hematology Oncology, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, United States
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14
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Wert A, Köditz H, Schwerk N. Progrediente Belastungsdyspnoe in der Adoleszenz – nicht immer Asthma. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0079-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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15
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Ng M, Pandya N, Conry B, Gale R. A case of panic to pulmonary embolism. BMJ Case Rep 2015; 2015:bcr-2015-209857. [PMID: 26071441 DOI: 10.1136/bcr-2015-209857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary embolism (PE) is a rare paediatric diagnosis, but its presence is likely to be underestimated due to the subtle and non-specific nature of its symptoms. Common clinical features of PE include shortness of breath, pleuritic chest pain and acute cardiovascular collapse. Less common symptoms can include persistent unexplained tachycardia, fever or deep vein thrombosis. Rarely do patients present with abdominal pain and self-resolving shortness of breath; symptoms our patient experienced. However, in contrast to popular belief, having normal vital signs does not necessarily lower the probability of PE. D-dimer, a specific fibrin degradation product, has a good negative predictive value for venous thromboembolism diagnosis but its use in children is less clear, with up to 40% of children with PE having a normal D-dimer level. CT pulmonary angiography remains the gold standard in diagnosis.
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Affiliation(s)
- Mansum Ng
- Department of Paediatrics, Tunbridge Wells Hospital, Tunbridge Wells, UK
| | - Nikila Pandya
- Department of Paediatrics, Maidstone and Tunbridge Wells, Kent, UK
| | - Brendon Conry
- Department of Radiology, Tunbridge Wells Hospital, Tunbridge Wells, UK
| | - Richard Gale
- Department of Haematology, Maidstone Hospital, Kent, UK
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16
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Ajdakar S, Elbouderkaoui M, Rada N, Drais G, Bouskraoui M. [Multiple pulmonary emboli complicating infective endocarditis in a child with congenital heart disease]. Arch Pediatr 2015; 22:401-4. [PMID: 25725970 DOI: 10.1016/j.arcped.2015.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/15/2014] [Accepted: 01/16/2015] [Indexed: 10/23/2022]
Abstract
Pulmonary embolism in children is a rare condition, associated with high mortality. Clinical presentation is nonspecific. Pulmonary embolism may present initially similar to bacterial endocarditis of the right heart, septic thrombophlebitis, or osteomyelitis. We report the case of a 6-year-old girl who had dyspnea over the four months before consultation, complicated three months later by hemoptysis. She was diagnosed with subacute bacterial endocarditis secondary to group D Streptococcus, developed upon a ventricular septal defect. Two weeks later, the child had sudden chest pain and tachypnea. Lung scintigraphy showed multiple pulmonary embolisms. The therapeutic approach was to continue antibiotics without anticoagulant treatment. The outcome was favorable with apyrexia and stabilization on the respiratory level. Pulmonary embolism is a rare disease in children with an incidence of 3.7%. Classically, it presents with fever, hemoptysis, and nonspecific infiltrates on chest X-ray. These signs were noted in our patient, although the infiltrates on the chest X-ray were hidden by the pulmonary edema associated with heart failure. The persistence of these left basal opacities after antidiuretic treatment suggested an infectious origin. Subsequently, lung scintigraphy showed that it was a pulmonary infarct. The therapy of septic pulmonary embolism is the same as that for infective endocarditis. Antibiotic treatment alone was maintained without anticoagulants because of the high risk of bleeding at the seat of the pulmonary embolism and the insubstantial significant benefit of this therapy. Pulmonary embolism in children is a rare disease, but its incidence is underestimated. Better knowledge on its actual impact and etiologies in children is necessary. Multicenter studies are needed to establish recommendations.
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Affiliation(s)
- S Ajdakar
- Service de pédiatrie A, faculté de médecine et de pharmacie de Marrakech, université Caddy Ayyad, hôpital Mère-Enfant, CHU Mohamed VI, Marrakech, Maroc.
| | - M Elbouderkaoui
- Service de pédiatrie A, faculté de médecine et de pharmacie de Marrakech, université Caddy Ayyad, hôpital Mère-Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - N Rada
- Service de pédiatrie A, faculté de médecine et de pharmacie de Marrakech, université Caddy Ayyad, hôpital Mère-Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - G Drais
- Service de pédiatrie A, faculté de médecine et de pharmacie de Marrakech, université Caddy Ayyad, hôpital Mère-Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - M Bouskraoui
- Service de pédiatrie A, faculté de médecine et de pharmacie de Marrakech, université Caddy Ayyad, hôpital Mère-Enfant, CHU Mohamed VI, Marrakech, Maroc
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Nicholson GT, Kogon B, Vincent R. AngioJet rheolytic thrombectomy in a neonate with pulmonary artery thrombus. Catheter Cardiovasc Interv 2013; 82:E704-7. [PMID: 23420640 DOI: 10.1002/ccd.24740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/29/2012] [Indexed: 11/08/2022]
Abstract
A newborn infant with obstructed supracardiac total anomalous pulmonary venous return underwent emergent surgical correction on day of life 0. A surgically placed transthoracic pulmonary artery catheter was used to monitor pulmonary artery pressure and removed on postoperative day 3. Following acute deterioration in respiratory status requiring reintubation, echocardiographic assessment demonstrated findings consistent with pulmonary hypertension and diminished flow to the left lung. Cardiac catheterization confirmed elevated pulmonary artery pressure and near complete occlusion of his left pulmonary artery due to a thrombus. He underwent successful percutaneous catheter-based thrombectomy using the AngioJet rheolytic catheter, recovered fully, and was discharged home on postoperative day 30. Although thrombotic events resulting in respiratory and hemodynamic compromise are rare in infants, recognition is important and treatment using mechanical thrombectomy can be life saving.
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Affiliation(s)
- George T Nicholson
- Division of Pediatric Cardiology and Department of Pediatrics, Emory University, Atlanta, Georgia
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18
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Left pulmonary artery thrombosis in a neonate with left lung hypoplasia. Case Rep Pediatr 2012; 2012:314256. [PMID: 23304599 PMCID: PMC3530762 DOI: 10.1155/2012/314256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 11/29/2012] [Indexed: 11/18/2022] Open
Abstract
Thrombotic events in neonates may origin from fetal life. A 4-day-old newborn infant with a family history of heterozygous type 1 protein C deficiency was diagnosed with left lung hypoplasia and left pulmonary artery thrombosis. Its source was prenatally closed ductus arteriosus. Surgical removal of the thrombus was performed.
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Oh HL, Kang HR, Jeon SC, Lee YH. Thromboembolic events identified during diagnosis of germ cell tumors in 2 children. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 47:233-6. [PMID: 23071481 PMCID: PMC3464343 DOI: 10.5045/kjh.2012.47.3.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 06/11/2012] [Accepted: 08/03/2012] [Indexed: 12/02/2022]
Abstract
We describe 2 cases in which radiographic evidence of thromboembolic events was obtained during germ cell tumor diagnosis. There was no evidence of coagulation factor abnormalities or contributory procedures or drugs in either patient. We used anticoagulation therapy for thrombolysis in one patient, but in the other, the thromboembolism resolved spontaneously.
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Affiliation(s)
- Hea-Lin Oh
- Department of Pediatrics, Hanyang University Medical Center, Seoul, Korea
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