Acute pulmonary embolism in children and adolescents in the USA (2016 and 2019): a nationwide retrospective cohort study

IF 38.7 1区医学 Q1 CRITICAL CARE MEDICINE

Lancet Respiratory Medicine Pub Date : 2025-02-04 DOI:10.1016/s2213-2600(24)00412-0

Simon Wolf, Luca Valerio, Nils Kucher, Stavros V Konstantinides, Irene L M Klaassen, C Heleen van Ommen, Cihan Ay, Frederikus A Klok, Suzanne C Cannegieter, Stefano Barco

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引用次数: 0

Abstract

Background

Epidemiological data on acute pulmonary embolism among children and adolescents are sparse and only date back to the 2000s. We aimed to establish annual estimates and age-stratified and sex-stratified indicators of acute pulmonary embolism among children and adolescents aged 0–19 years.

Methods

We did a retrospective, nationwide, patient-level analysis of the Kids’ Inpatient Database, including 5733 patients with acute pulmonary embolism aged 0–19 years admitted to hospital in the USA in 2016 and 2019. The database includes data of all children admitted to hospital during the 2 years available. We also accessed the US Multiple Cause of Death database and population data from the US Census Bureau for the same 2 years. We estimated the incidence, mortality, case fatality, and proportional mortality rates, provided data on the annual pulmonary embolism burden, and provided data on clinical events recorded during hospitalisation.

Findings

In the years 2016 and 2019, 5733 patients (3353 [58.5%] female and 2380 [41.5%] male) were admitted to hospital with acute pulmonary embolism as the primary diagnosis or a concomitant diagnosis. The annual incidence of acute pulmonary embolism was 3·5 (95% CI 3·4–3·6) per 100 000 people. Two peaks in the incidence rate were observed—one in infants younger than 1 year and one in adolescents aged 15–19 years. The in-hospital case fatality rate was 4·5% (4·0–5·1). The crude odds ratio for in-hospital death among patients with (vs without) acute pulmonary embolism was 9·3 (7·9–10·9). The association between acute pulmonary embolism and death persisted across different multivariable models. Patients with acute pulmonary embolism with high-risk (vs no high-risk) features had the highest risk of death: 25·3% (20·6–30·5) among patients aged 0–9 years and 13·9% (11·9–16·2) among patients aged 10–19 years. In patients without high-risk features, risk of death was 4·9% (3·1–7·6) among patients aged 0–9 years and 0·7% (0·5–1·0) among patients aged 10–19 years. The risk of intracranial bleeding was also highest in the presence of pulmonary embolism with high-risk features: 8·1% (5·5–11·7) among patients aged 0–9 years and 3·6% (2·6–4·9) among patients aged 10–19 years. In patients without high-risk features, the risk of intracranial bleeding was 2·5% (1·3–4·6) among those aged 0–9 years and 0·5% (0·3–0·8) in those aged 10–19 years. Reperfusion treatments beyond systemic thrombolysis were rarely used among children and adolescents with acute pulmonary embolism.

Interpretation

Acute pulmonary embolism is rare during childhood and adolescence. The high pulmonary embolism-related fatality among specific subgroups of patients can be interpreted in the context of severe comorbidities and pulmonary embolism events with high-risk features.

Funding

None.

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美国儿童和青少年急性肺栓塞（2016年和2019年）：一项全国性回顾性队列研究

儿童和青少年急性肺栓塞的流行病学数据很少，而且只能追溯到2000年代。我们的目的是建立0-19岁儿童和青少年急性肺栓塞的年度估计和年龄分层和性别分层指标。方法：我们对儿童住院患者数据库进行了全国性的患者水平回顾性分析，包括2016年和2019年在美国住院的5733例0-19岁急性肺栓塞患者。该数据库包括两年内所有住院儿童的数据。我们还访问了美国多死因数据库和美国人口普查局同样两年的人口数据。我们估计了发病率、死亡率、病死率和比例死亡率，提供了每年肺栓塞负担的数据，并提供了住院期间记录的临床事件的数据。结果2016年和2019年，以急性肺栓塞为主要诊断或合并诊断的住院患者5733例（女性3353例（58.5%），男性2380例（41.5%））。急性肺栓塞的年发病率为每10万人3.5例（95% CI 3.4 - 3.6）。发病率有两个高峰，一个在1岁以下的婴儿中，一个在15-19岁的青少年中。住院病死率为4.5%（4.0 ~ 5.1）。急性肺栓塞患者（与非急性肺栓塞患者）住院死亡的粗优势比为9.3（7.9 - 10.9）。急性肺栓塞与死亡之间的关联在不同的多变量模型中持续存在。具有高危（与无高危）特征的急性肺栓塞患者的死亡风险最高：0-9岁患者的死亡率为25.3%(20.6 - 30.5)，10-19岁患者的死亡率为13.9%（11.9 - 16.2）。在无高危特征的患者中，0 ~ 9岁患者死亡风险为4.9%(3.1 ~ 7.6)，10 ~ 19岁患者死亡风险为0.7%（0.5 ~ 0.0）。存在肺栓塞的高危特征，颅内出血的风险也最高：0-9岁患者为8.1%(5.5 - 11.7)，10-19岁患者为3.6%（2.6 - 4.9）。在无高危特征的患者中，0 ~ 9岁颅内出血风险为2.5%(1·3 ~ 6)，10 ~ 19岁颅内出血风险为0.5%（0·3 ~ 0.8）。儿童和青少年急性肺栓塞患者很少采用全身溶栓以外的再灌注治疗。急性肺栓塞在儿童和青少年是罕见的。特定亚组患者的高肺栓塞相关病死率可以在严重合并症和具有高风险特征的肺栓塞事件的背景下解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Respiratory Medicine RESPIRATORY SYSTEM-RESPIRATORY SYSTEM

CiteScore

87.10

自引率

0.70%

发文量

572

期刊介绍： The Lancet Respiratory Medicine is a renowned journal specializing in respiratory medicine and critical care. Our publication features original research that aims to advocate for change or shed light on clinical practices in the field. Additionally, we provide informative reviews on various topics related to respiratory medicine and critical care, ensuring a comprehensive coverage of the subject. The journal covers a wide range of topics including but not limited to asthma, acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), tobacco control, intensive care medicine, lung cancer, cystic fibrosis, pneumonia, sarcoidosis, sepsis, mesothelioma, sleep medicine, thoracic and reconstructive surgery, tuberculosis, palliative medicine, influenza, pulmonary hypertension, pulmonary vascular disease, and respiratory infections. By encompassing such a broad spectrum of subjects, we strive to address the diverse needs and interests of our readership.