Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014

Abstract

Abstract: Although rare in children, pulmonary embolism (PE) can cause significant morbidity and mortality. Overall rates of venous thromboembolism (VTE) are increasing in hospitalized children. By using the Pediatric Health Information System database, we evaluated incidence, treatment, and outcome of PE in children younger than age 18 years from 2001 to 2014. Demographic characteristics for those admitted with VTE alone and those admitted with PE were compared. Rates of PE by year were compared with the number of hospital and VTE admissions. Trends in medication use were analyzed. Over the period of the study, patients with PE made up 15.8% of VTE discharges. The overall rate of PE increased 200% (P < .001). Compared with all other age groups, adolescents (age 13-18 years) had the highest prevalence (55%; P < .001), the rate of which increased from 9.8 to 24.7 per 10 000 hospital discharges (152%; P < .001), and from 17.5 to 34.1 per 100 VTE discharges (95%; P < .001). Individuals with PE had a higher mortality (8.3% vs 6%; P < .001) and were less likely to have a complex chronic condition (58% vs 65%; P < .001) than those with VTE alone. However, PE mortality rates decreased over the time period studied. African American and Hispanic patients were more likely to experience recurrent PE than white patients (12% and 10.7% vs 8%; P = .002). During the study period, the use of unfractionated heparin decreased (P < .001), and the use of low molecular weight heparin increased (P < .001). Further research is required to determine what factors contribute to the higher rate of PE in adolescents and influence recurrence in African American and Hispanic patients.