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Oral Communication

Pediatrics

The Spectrum of Pediatric Bleeding and Clotting: From Genes to Long-Term Related Outcomes

OC 48.5 - Respiratory, Cardiac, and Exertional Function Post-Pulmonary Embolism in Children

Monday, June 26, 2023

15:45 – 16:00 ET

Room: 518

Session Available As: On-Demand

Co-Author(s)

Denise M. Bastas, MSc

Clinical Research Project Assistant
The Hospital for Sick Children
Oxford, England, United Kingdom

Co-Author(s)

Leonardo R. Brandão, MD, MSc (he/him/his)

Staff Hematologist, Thrombosis Program Director, Professor of Paediatrics
The Hospital for Sick Children, University of Toronto
Toronto, Ontario, Canada
DW

David Wilson

Pulmonary Function Technologist
The Hospital for Sick Children
Toronto, Ontario, Canada
LP

Lucy Perrem

Staff Physician
The Hospital for Sick Children
Toronto, Ontario, Canada
RB

Robert Bentley

Assistant Professor
University of Toronto
Toronto, Ontario, Canada
GW

Gina Wong

Clinical Research Project Assistant
The Hospital for Sick Children
Toronto, Ontario, Canada
JS

Jane Schneiderman

Exercise Physiologist
The Hospital for Sick Children
Toronto, Ontario, Canada
Jennifer Vincelli, MN, RN (EC)

Nurse Practitioner
The Hospital for Sick Children
Toronto, Ontario, Canada
NA

Nour Amiri

Clinical Research Project Coordinator
The Hospital for Sick Children
Toronto, Ontario, Canada
SW

Suzan Williams, MD

Staff Physician
The Hospital for Sick Children
Toronto, Ontario, Canada

Presenting Author(s)

Laura Avila, MD, PhD

Clinician Scientist
The Hospital for Sick Children
Toronto, Ontario, Canada

Background: Knowledge regarding long-term consequences of pulmonary embolism (PE) in children is limited.

Aims: This cohort study describes the long-term outcomes of PE in children at a single-center institution between 2004-2022, investigated using an existing local protocol.

Methods: Children objectively diagnosed with PE at 0-18 years who had ≥6 months of follow-up were included (excluding tumor thrombus, septic PE, and in-situ PE). Follow-up data consisted of subjective findings (dyspnea/exercise intolerance), PE resolution/recurrence by imaging, pulmonary function test (PFT), echocardiograms, and cardiopulmonary exercise test (CPET). PFT data were analyzed using age-appropriate reference values from the Global Lung Function Initiative. The frequency of long-term outcomes was summarized and compared between patients with/without underlying conditions. Ethics approval was obtained.

Results: 165 patients sustained a PE in the study period; 15 were excluded (early death n=10, hospital transfer n=4, lung transplant post-PE n=1). Table 1 shows the characteristics of the population (n=150) and time to outcome assessment.
Median length of follow-up was 476 days (25th-75th percentile, 218-994 days). Dyspnea/exercise intolerance was documented in 27% (41/150); only 4% (6/150) had persistent symptoms (lasting ≥1 month); symptoms were attributed to other conditions in 5/6 patients.
Abnormal echocardiogram findings, including abnormal right ventricle function/diameter, were seen in 4% (5/141); 4/5 were abnormal pre-PE.
PE fully resolved in 71% (96/136); recurrence was seen in 9% (13/150) at a median 180 days (25th-75th percentile, 77-250 days). Four patients died (median time 365 days, 25th-75th percentile, 340-388 days), 3 due to underlying conditions.
In total, 115 patients had good quality PFTs at follow-up; 50% had ≥1 abnormal parameter z-score. Abnormal aerobic capacity (VO2-peak z-score below -1.96) was seen in 5/50 (10%) patients with peak CPET data available.
Outcomes according to underlying conditions are shown in Table 2.

Conclusion(s): This study characterized the frequency of long-term outcomes of paediatric PE, and the impact of underlying conditions.

Learning Objectives:

Upon completion, participants will be able to describe the long-term outcomes of pulmonary embolism in pediatric patients.
Upon completion, participants will be able to improve management strategies to effectively monitor long-term outcomes of pulmonary embolism in pediatric patients.
Upon completion, participants will be able to recognize the consequences of deconditioning in these patients and the need to prevent and manage pulmonary embolism associated deconditioning.