Study finds higher rates of pulmonary embolism in pediatric patients

Pulmonary embolism in children has been acknowledged to be an issue in clinical care but was thought to be rare. Now new research published at the ATS 2025 International Conference shows that it is much more common than previously understood.

In a large new study, researchers found an unexpectedly high frequency of pulmonary embolism in pediatric patients - equal to rates seen in adults. It's the first-ever prospective study to look at rates of pulmonary embolism in children.

PE in children is not as rare as previously thought and needs to be considered in adolescents with unexplained dyspnea," or shortness of breath."

Jeffrey A. Kline, MD, first author, professor of emergency medicine at Wayne State University School of Medicine

Previous retrospective studies using patient databases suggested that PE occurred in fewer than 1 in 100,000 children per year. But the new study found that as many as 6.3 percent of children who present with suspicious symptoms may be diagnosed with acute PE.

The abstract presented at ATS provides the first data to be released from the BEdside Exclusion of Pulmonary Embolism in children without the need for Radiation (BEEPER) multicenter study.

The study involved 4011 children presenting at 21 U.S. emergency departments with symptoms suggesting evaluation for PE. The patients ranged in age from 4 to 17.

Further testing found that 3.0 percent of the children had pulmonary embolism alone; 1.8 percent had deep vein thrombosis (DVT); and 1.3 percent had both conditions. Perhaps less surprising than the frequency itself, Dr. Kline noted that the patterns that helped distinguish PE in children were similar to those seen in adults.

In addition to the findings themselves, the study provides the first-ever criteria for clinicians who suspect PE in children to begin a diagnostic workup. The criteria considered by researchers provide an evidence-based approach to testing for PE in children who otherwise would have gone undiagnosed, while at the same time reducing low-value exposure to radiation, Dr. Kline noted.

Nearly 80 percent of the patients received a D-dimer test as the initial diagnostic test. This involves a blood test that can detect markers of blood clots. Other imaging tests were used to make the diagnosis, including computed tomographic pulmonary angiography (CTPA), VQ lung scan, MRI, and venous ultrasound.

Kline said the results raised important questions.

"This is the most thought-provoking part of our findings," he said. "Do children experience PE commonly and remain undiagnosed, but then recover without sequela? Or are we missing the opportunity to intervene earlier on an unrecognized cause of pulmonary hypertension or other chronic disability or rarely, cause of sudden death?"

Next, the researchers plan to follow up on this work with a multicenter study investigating whether new guidelines help safely rule out PE in children without unnecessary tests.