Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO; and.
Children's Hospital Association, Lenexa, KS.
Blood Adv. 2018 Jun 26;2(12):1403-1408. doi: 10.1182/bloodadvances.2017013292.
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% ( < .001). Compared with all other age groups, adolescents (age 13-18 years) had the highest prevalence (55%; < .001), the rate of which increased from 9.8 to 24.7 per 10 000 hospital discharges (152%; < .001), and from 17.5 to 34.1 per 100 VTE discharges (95%; < .001). Individuals with PE had a higher mortality (8.3% vs 6%; < .001) and were less likely to have a complex chronic condition (58% vs 65%; < .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%; = .002). During the study period, the use of unfractionated heparin decreased ( < .001), and the use of low molecular weight heparin increased ( < .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.
虽然在儿童中很少见，但肺栓塞 (PE) 可导致显著的发病率和死亡率。在住院儿童中，静脉血栓栓塞症 (VTE) 的总体发生率正在增加。我们使用儿科健康信息系统数据库，评估了 2001 年至 2014 年期间年龄小于 18 岁的儿童中 PE 的发病率、治疗和结局。比较了仅患有 VTE 和同时患有 PE 的患者的人口统计学特征。比较了每年的 PE 发生率与住院和 VTE 入院人数。分析了药物使用的趋势。在研究期间，PE 患者占 VTE 出院患者的 15.8%。PE 的总体发生率增加了 200%（ <.001）。与所有其他年龄组相比，青少年（13-18 岁）的患病率最高（55%； <.001），其发病率从每 10000 次住院出院 9.8 例增加到 24.7 例（152%； <.001），从每 100 例 VTE 出院 17.5 例增加到 34.1 例（95%； <.001）。患有 PE 的个体死亡率更高（8.3%比 6%； <.001），且患有复杂慢性疾病的可能性低于仅患有 VTE 的个体（58%比 65%； <.001）。然而，在研究期间，PE 死亡率呈下降趋势。非裔美国人和西班牙裔患者比白人患者更有可能经历复发性 PE（12%和 10.7%比 8%； =.002）。在研究期间，未分级肝素的使用减少（ <.001），低分子量肝素的使用增加（ <.001）。需要进一步研究以确定哪些因素导致青少年中 PE 发生率较高，并影响非裔美国人和西班牙裔患者的复发。
