title: Pulmonary embolism in the pediatric emergency department.
abstract: OBJECTIVE
  To describe patients who present to the pediatric emergency department (PED) and are subsequently diagnosed with pulmonary embolism (PE).
  
  
  METHODS
  Electronic medical records from 2003 to 2011 of a tertiary care pediatric health care system was retrospectively reviewed to identify patients <21 years who had a final International Classification of Diseases, Ninth Revision diagnosis of PE. Patient demographics, and hospital course were recorded. Adult validated clinical decision rules Wells criteria and Pulmonary Embolism Rule-out Criteria (PERC) were retrospectively applied. PERC identified 8 clinical criteria for adult patients using logistic regression modeling to exclude PE without additional diagnostic evaluation. If all criteria are met, further evaluation is not indicated.
  
  
  RESULTS
  Of 1 185 794 PED visits, 105 patients had an ultimate diagnosis of PE. Twenty-five met study criteria, and all were admitted. Forty percent of these patients had PE diagnosed in the PED. The most common risk factors were BMI ≥25 (50%, 10 of 20), oral contraceptive use (38% 5 of 13 female patients), and history of previous thrombus without PE (28%, 7 of 25). When the PERC rule was applied retrospectively, 84% of patients could not be ruled out, indicating additional evaluation for PE was needed.
  
  
  CONCLUSIONS
  Pulmonary embolism is rare in children but does occur. This study emphasizes risk factors among children that should raise the suspicion of PE. Additional studies are needed to further evaluate risk factors and signs and symptoms of PE to develop pediatric specific clinical decision rules to provide reliable and reproducible means of determining pretest probability of PE.
authors.affiliation: DO, 1645 Tullie Circle, Atlanta, GA 30329. bagha@emory.edu.
authors.forename: Beesan Shalabi
authors.initials: BS
authors.lastname: Agha
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Sturm
authors.forename: Harold K
authors.initials: HK
authors.lastname: Simon
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hirsh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000379:methods* / Q000639:trends; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Pulmonary Embolism Rule-out Criteria (PERC); Wells criteria; pediatric emergency department; pulmonary embolism