(523) Pediatric Admissions With Pulmonary Embolism Over Time in a Quaternary Care Children's Hospital

Introduction: Per previous studies, the incidence of pulmonary embolism in children varies widely and may be increasing over time, although more recent data are lacking. We performed a single center retrospective study to characterize the epidemiology of children hospitalized with pulmonary embolism over a 10-year period.

Methods: The study was approved by the institutional review board at Nationwide Children’s Hospital, which granted a waiver of informed consent. Patients were eligible for inclusion if they were admitted to any unit in the hospital between January 1, 2013 and December 31, 2023. Potential cases were identified by ICD-10 or SNOMED CT codes for pulmonary embolism in the admission diagnosis, discharge diagnosis, or encounter problem list. Cases were confirmed if there was radiographic evidence of PE. Subjects were excluded if they were over 18 years of age or if the PE had occurred over 24 hours prior to admission. Data were collected electronically from the electronic health record, with manual chart review to validate electronic data collection. Negative binomial models were used to evaluate change in PE diagnosis over time, accounting for the total number of non-neonatal intensive care unit hospital admissions each year.

Results: 142 children with acute PE were included (0.88 per 1,000 admissions). 64% were female, median age 16 [IQR: 14, 17] years old. The median BMI was 28 [21, 35]. In-hospital all-cause mortality was 3.5%. Yearly PE cases per 1,000 admissions ranged from a low of 0.26 in 2013 to a high of 1.38 in 2022. Median cases per 1,000 admissions pre vs. post COVID-19 were 0.63 [0.37, 0.85] vs 1.3 [1.2, 1.4], p = 0.006, Mann-Whitney. However, annual cases had been steadily increasing over time except for a decrease in cases in 2019. Overall, there was a statistically significant increase in PE cases over the ten-year period, with an estimated 12.7% increase per year (p < 0.001).

Conclusions: Over the past decade, there has been a significant increase in children hospitalized to our institution with pediatric PE. Given the morbidity and mortality associated with PE, the upward trend in incidence underscores the need for heightened awareness and improved diagnostic strategies.