CLINICAL CRITERIA FOR IMAGING CHILDREN AT RISK FOR PULMONARY EMBOLISM.

Introduction : Pulmonary embolism (PE) is a rare, but serious condition in children. Clinical Guidelines for imaging a suspected pediatric PE, in Pediatric Emergency Medicine [PEM] are lacking. The computerized Tomography Pulmonary Angiogram (CTPA) is the preferred diagnostic modality for suspected PE in an emergency room. Our study aims to introduce a simplified clinical assessment-based tool for ordering CTPA in children in an emergency room setting. Methods : This is a retrospective review of patients managed in our Emergency Department from 2000 to 2020. Patients were identified based on the International Classification of Disease codes related to PE, deep vein thrombosis, or similar diagnoses. The control group was patients with symptoms of PE, seen in the same time frame as the study group, who had negative CTPA. Results : Twenty-five CTPA-positive patients were identified. Twenty three of 25 CTPA positive patients were between 13 to 18 years old. Common risk factors included here are protein-losing state i.e. nephrotic syndrome. Others include oral contraceptive pill use, and obesity. Chest pain and tachypnea were the most common complaint and clinical sign, respectively. Hypercoagulability screen was negative in 65% of the patients. The mean D-dimer was 5.27 g/ml, and 6 patients—of whom 4 had saddle PE—had D-dimer > 10. Reoccurrence of PE and neuro-deficits was noted in 2 patients each. Conclusion : We present clinical criteria for ordering CTPA in children with suspected PE, based on data from our center, and a literature review of pediatric studies. Further multicentric studies, with larger samples, are needed to validate our suggested criteria.