title: Risk factors and clinical features of acute pulmonary embolism in children from the community.
abstract: OBJECTIVE
  Current clinical decision rules for pulmonary embolism are based on adult populations and have not been validated in children. The objective was to identify and evaluate clinical features for a first lifetime episode of pulmonary embolism in children presenting to the emergency department.
  
  
  METHODS
  We present a case-control study of children (≤18years) presenting to the emergency department of the Royal Children's Hospital, Melbourne between November 2007 and February 2015. Children with radiologically proven pulmonary embolism formed the case group, whilst children in whom there was a clinical suspicion of pulmonary embolism but negative diagnostic imaging formed the control group. Charts, electronic medical and imaging records of both cases and controls were reviewed and analysed.
  
  
  RESULTS
  There were a total of 50 patients in this study (11 cases and 39 controls). Current or recent (within three months) use of the oral contraceptive pill was the most significant risk factor in our study (odds ratio 14.667, 95% confidence interval 3.001-71.678, P<0.001). Most other features failed to discriminate between cases and controls, although there was a trend towards increased heart rate in cases.
  
  
  CONCLUSIONS
  Pulmonary embolism is perhaps the most common presenting spontaneous venous thromboembolism in the community and teenage girls on the oral contraceptive pill are most at-risk amongst children. The clinical signs and symptoms are often non-specific. Additional larger studies are required to determine the significance and magnitude of potential clinical predictors identified in this study. This may lead to derivation of a paediatric-specific pre-test probability tool.
authors.affiliation: Department of Surgery, Monash University, Clayton, Victoria 3168, Australia; School of Clinical Sciences, Monash Health, Clayton, Victoria 3168, Australia. Electronic address: cywan14@student.monash.edu.
authors.forename: Charlie Yue
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Haematology Research Group, Murdoch Children's Research Institute, Clayton, Victoria 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria 3052, Australia. Electronic address: verai@unimelb.edu.au.
authors.forename: Vera
authors.initials: V
authors.lastname: Ignjatovic
authors.affiliation: Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: peter.francis@rch.org.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Francis
authors.affiliation: Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: tim.cain@rch.org.au.
authors.forename: Timothy
authors.initials: T
authors.lastname: Cain
authors.affiliation: The Cardiology Department, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: franz.babl@rch.org.au.
authors.forename: Franz
authors.initials: F
authors.lastname: Babl
authors.affiliation: Department of Medical Imaging, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: remi.kowalski@rch.org.au.
authors.forename: Remi
authors.initials: R
authors.lastname: Kowalski
authors.affiliation: Department of Surgery, Monash University, Clayton, Victoria 3168, Australia; Department of Cardiothoracic Surgery, Monash Health, Clayton, Victoria 3168, Australia. Electronic address: andrew.cochrane@monashhealth.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cochrane
authors.affiliation: Haematology Research Group, Murdoch Children's Research Institute, Clayton, Victoria 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria 3052, Australia; Clinical Haematology Group, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia. Electronic address: paul.monagle@rch.org.au.
authors.forename: Paul
authors.initials: P
authors.lastname: Monagle
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000473:pathology; D011655:Pulmonary Embolism / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D003277:Contraceptives, Oral, Combined
keywords: Child; Hospital emergency service; Pulmonary embolism; Risk factors