Intermediate- and high-risk pulmonary embolism in pediatric tertiary care centers in the Netherlands. Is there a need for a pediatric PERT?

Introduction: Pulmonary Embolism Response Teams (PERTs) are increasingly implemented to improve the management and outcomes of patients with severe pulmonary embolism (PE).(1) To assess the need and feasibility of pediatric PERTs in the Netherlands, it is crucial to understand the current epidemiology, management strategies, and outcomes of severe PE in children.

Aim: To assess the incidence, management approaches, and short term outcomes of intermediate- and high-risk PE in pediatric patients in the Netherlands.

Method: This retrospective chart review included children (aged 0-18 years) with acute intermediate- and high-risk PE across six pediatric tertiary care centers in the Netherlands from 2012 to 2022.

Results: A total of 172 pediatric PE patients were included, with 19 (11%) diagnosed with intermediate-risk PE and 17 (10%) with high-risk PE. The estimated annual incidence of intermediate- and high-risk PE was 1.0 case per million children in the Netherlands, with nearly 70% being adolescents. The most common presenting signs and symptoms included dyspnea (28/31, 88%) and chest pain (20/29, 69%). The most prevalent risk factors included the use of oral contraceptives (12/21, 57%) and congenital thrombophilia (12/28, 43%). In the high-risk group, reperfusion therapy was performed in 16/17 (94%) high-risk PE patients: systemic thrombolysis (n=12), surgical thrombectomy (ST) (n=3) and catheter-directed therapy (CDT) (n=1). Systemic thrombolysis was unsuccessful in four patients, who subsequently underwent CDT (n=3) and ST (n=1). Major bleeding occurred in 2 patients (12%), 2 patients (12%) had PE-related death. In the intermediate-risk group, reperfusion therapy was provided in 9/19 (47%) patients: systemic thrombolysis (n=8) and CDT (n=1). Major bleeding occurred in 2 patients (11%). No patients died. Maintenance therapy consisted of low-molecular-weight heparin (n=11), vitamin K antagonists (n=7) or directs oral anticoagulants (n=16) [1].

Conclusion: Severe PE is rare in the Netherlands, averaging about one case per tertiary center every two years. Variations in indications and types of reperfusion therapy suggest a need for national multidisciplinary care pathways to improve consistency and outcomes in pediatric PE management.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2025

• References

• 1 Rajpurkar M.. et al. Considerations for instituting pediatric pulmonary embolism response teams: A tool kit. Throm Res 2024; 236: 97-107