关键词: epidemiology pediatrics public health surveillance pulmonary embolism thrombosis

Mesh : Humans Pulmonary Embolism / diagnosis epidemiology mortality therapy Female Adolescent Canada / epidemiology Child Male Risk Factors Child, Preschool Incidence Anticoagulants / therapeutic use Infant Time Factors Infant, Newborn Thrombolytic Therapy Computed Tomography Angiography Age Factors Treatment Outcome

来  源:   DOI:10.1016/j.jtha.2024.01.005

Abstract:
BACKGROUND: Pediatric pulmonary embolism (PE) is a rare event associated with significant morbidity and mortality. Awareness of clinical presentation and practices unique to children may aid clinicians in prompt identification and treatment.
OBJECTIVE: To describe the incidence, risk factors, clinical presentation, diagnostic and therapeutic practices, and short-term outcomes of pediatric PE.
METHODS: We conducted a 3-year national surveillance study through the Canadian Pediatric Surveillance Program. Over 2800 pediatric specialists and subspecialists were contacted monthly from 2020 to 2022 and requested to report all new cases of PE in patients up to 18 years of age. Case-specific data were obtained through voluntary completion of a detailed questionnaire.
RESULTS: Fifty-eight cases (78% female, n = 45) were reported (2.4 cases per million children), with rates highest in adolescents 15 to 18 years (6.6 cases per million). Detailed information, available for 31 (53%) cases, documented at least 1 risk factor in 28 (90%) cases; 24 (77%) patients presented with 2 or more symptoms. Computed tomography pulmonary angiography was used for diagnostic confirmation in 25 (81%) cases. Anticoagulation was initiated in 24 (77%) of 31 cases; fewer than 5 patients underwent thrombolysis or surgical interventions. Of 28 patients who received therapeutic interventions, 8 (29%) experienced treatment-related complications. Fewer than 5 mortalities were reported.
CONCLUSIONS: Pediatric PE is a rare event, with female adolescents at the highest risk. Although the presentation is often nonspecific, clinicians should maintain a high index of suspicion, particularly in patients with risk factors and when other diagnoses that may explain symptoms have been excluded.
摘要:
背景:小儿肺栓塞(PE)是一种罕见事件,与高发病率和死亡率相关。对儿童特有的临床表现和实践的认识可以帮助临床医生及时识别和治疗。
目的:为了描述发病率,危险因素,临床表现,诊断和治疗实践,和小儿PE的短期结果。
方法:我们通过加拿大儿科监测项目进行了一项为期3年的全国监测研究。从2020年到2022年,每月联系2,800多名儿科专家和子专家,并要求报告18岁以下患者的所有新PE病例。具体病例数据是通过自愿填写详细问卷获得的。
结果:58例(78%为女性,n=45)报告(每百万儿童2.4例),在15至18岁的青少年中发病率最高(每百万6.6例)。详细信息,适用于31例(53%),在28例(90%)病例中记录了至少1个危险因素;24例(77%)患者出现2种或更多种症状。在25例(81%)病例中,使用计算机断层扫描肺动脉造影进行诊断确认。31例中有24例(77%)开始抗凝治疗;不到5例患者接受了溶栓或手术干预。在接受治疗干预的28名患者中,8例(29%)出现治疗相关并发症。据报道死亡人数少于5人。
结论:小儿PE是一种罕见事件,女性青少年风险最高。虽然介绍通常是非特定的,临床医生应该保持高度怀疑,特别是在有危险因素的患者中,当其他可能解释症状的诊断被排除时.
公众号