Abstract 13363: Incidence, Management, and Outcomes of Pediatric Pulmonary Embolism in the United States: An Observational Study Using Data From the Pediatric Health Information Systems Database

Introduction: Pulmonary embolism (PE) is a rare but potentially severe disease. Strategies for treatment in adults are evolving to increasingly include local thrombolysis and thrombectomy, in addition to mainstay treatment of anticoagulation (AC). Neither the incidence of pediatric PE nor contemporary evidence on treatment have been well studied, so this study addresses these knowledge gaps by describing PE patients and their treatment outcomes. Methods: A retrospective multicenter cohort study was performed using patients ≤18 years with PE at US hospitals contributing data to the Pediatric Health Information Systems Database from 1/1/2015-9/1/2021. This study 1) described the clinical characteristics of PE patients, 2) examined trends in treatment strategies, and 3) used multivariable models to examine the relationship between treatment and outcomes (in-hospital mortality, length of stay (LOS), and adjusted costs of hospitalization). Results: In total, 3148 unique patients with PE were studied (54% female, median age 15 years). Most patients (63%) had at least one comorbid condition, the most common being congenital heart disease (25%). Most patients received anticoagulation only (88%), 7% underwent systemic thrombolysis, and 5% underwent local thrombolysis and/or thrombectomy. In-hospital mortality was 7.5%, with 62% of patients requiring ICU admission, and 7.4% receiving extracorporeal membrane oxygenation. Median (IQR) LOS was 10 days (21) and median cost was $54,026 (145,231). Use of thrombectomy and thrombolysis did not increase over time (p=0.98). In multivariable analysis, receipt of local thrombolysis and/or thrombectomy was associated with lower mortality (adjusted OR: 0.54, p=0.03). Systemic thrombolysis (β=1.73, p<0.001) and local thrombolysis and/or thrombectomy (β=1.35, p=0.003) were associated with higher costs than AC alone, without significant associations between treatment and LOS. Conclusion: Pediatric PE is associated with high mortality and healthcare utilization, reflecting the medical complexity of the patients. Rates of local thrombolysis and thrombectomy remain low, and further study is required to elucidate which patients may benefit from such procedural management.