Post pulmonary embolism syndrome following paediatric pulmonary embolism: a multicentre, retrospective cohort study.

Abstract

Pulmonary embolism is a rare but serious condition in children. Although post pulmonary embolism syndrome is well documented in adults, its occurrence and risk factors in children remain poorly understood, despite being essential for improving and personalising paediatric pulmonary embolism care. We aimed to determine the prevalence of post pulmonary embolism syndrome in children with pulmonary embolism, and to identify clinical factors for physical limitations associated with post pulmonary embolism syndrome during follow-up. We did a multicentre, retrospective cohort study including children aged 0-18 years who were treated for symptomatic pulmonary embolism in six tertiary paediatric hospitals in the Netherlands from January 1, 2012, to Dec 31, 2022. Clinical and follow-up data were extracted from electronic medical records. The primary outcome was the prevalence of post pulmonary embolism syndrome at 3 months, 1 year, and 2 years post pulmonary embolism. The secondary outcome was physical restriction at 1 year post pulmonary embolism. Clinical factors associated with post pulmonary embolism syndrome were analysed using a multivariate analysis with confounders identified using directed acyclic graph. A total of 183 paediatric patients with pulmonary embolism were eligible for study inclusion. Four patients were excluded due to insufficient follow-up data and one patient died, resulting in 178 patients (115 [65%] female, 63 (35%) male; median age 15·0 years [IQR 13·0-16·0]) included in the study. 178 (100%) participants completed follow-up at 3 months, 167 (94%) completed follow-up at 1 year, and 165 (93%) completed follow-up at 2 years. 63 (35%) patients developed post pulmonary embolism syndrome with the 2 years, and 115 (65%) patients did not. The prevalence of post pulmonary embolism syndrome was 35% at 3 months (63 of 178), 24% at 1 year (41 of 168) and 16% at 2 years (25 of 161). Clinical factors associated with physical limitations at 1 year included incomplete thrombus resolution (odds ratio [OR] 3·8 [95% CI 1·4-10·3], p=0·0090), paediatric intensive care unit admission (OR 2·8 [1·2-7·6], p=0·017), intermediate-risk or high-risk pulmonary embolism (OR 4·1 [95% CI 1·8-9·4], p=0·0010), comorbidity (OR 2·9 [1·3-6·4], p=0·010), ongoing treatment (OR 2·8 [1·2-6·5], p=0·016), and psychological distress 3 months post pulmonary embolism (OR 4·3 [1·9-9·8], p=0·0010). Exercise at least 3 times per week was inversely associated with physical limitations (OR 0·31 [95% CI 0·1-0·8], p=0·0090). This study showed a high prevalence of post pulmonary embolism syndrome in children with pulmonary embolism. Different clinical factors can contribute, including psychological distress factors and physical limitations, emphasising the need for comprehensive, multidisciplinary care. None.