title: Detection of Pulmonary Embolism in High-Risk Children.
abstract: OBJECTIVE
  To evaluate 2 commonly used adult-based pulmonary embolism (PE) algorithms in pediatric patients and to derive a pediatric-specific clinical decision rule to evaluate children at risk for PE, given the paucity of data to guide diagnostic imaging in children for whom PE is suspected.
  
  
  METHODS
  We performed a single-center retrospective study among 561 children <22 years of age undergoing either D-dimer testing or radiologic evaluation (computed tomography or ventilation-perfusion scan) in the emergency department setting for concern of PE. A diagnosis of PE required radiologic confirmation and anticoagulant treatment. We evaluated the test characteristics of the Wells criteria and Pulmonary Embolism Rule-out Criteria (PERC) low-risk rule and used recursive partition analysis to derive a clinical decision rule.
  
  
  RESULTS
  Among the 561 patients included in the study, 36 (6.4%) were diagnosed with PE. The Wells criteria demonstrated a sensitivity and specificity of 86% and 60%, respectively. The sensitivity and specificity of the PERC were 100% and 24%, respectively. A clinical decision rule including the presence of oral contraceptive use, tachycardia, and oxygen saturation <95% demonstrated a sensitivity and specificity of 90% and 56%, respectively, a positive and negative likelihood ratio of 2.0 and 0.2, and a positive and negative predictive value of 0.12 and 0.99, respectively.
  
  
  CONCLUSIONS
  The risk of PE is low among children not receiving estrogen therapy and without tachycardia and hypoxia in those with an initial suspicion of PE. Application of the PERC rule and Wells criteria should be used cautiously in the pediatric population.
authors: Division of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, MO. Electronic address: Hennelly_K@kids.wustl.edu.
authors: Kara E
authors: KE
authors: Hennelly
authors: Divisions of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors: Marc N
authors: MN
authors: Baskin
authors: Divisions of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors: Michael C
authors: MC
authors: Monuteuax
authors: Divisions of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors: Joel
authors: J
authors: Hudgins
authors: Divisions of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors: Eugene
authors: E
authors: Kua
authors: Divisions of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors: Ashlee
authors: A
authors: Commeree
authors: Divisions of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors: Rotem
authors: R
authors: Kimia
authors: Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors: Edward Y
authors: EY
authors: Lee
authors: Divisions of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors: Amir
authors: A
authors: Kimia
authors: Divisions of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA.
authors: Mark I
authors: MI
authors: Neuman
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D015331:Cohort Studies; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: pulmonary embolism