Considerations for instituting pediatric pulmonary embolism response teams: A tool kit

Madhvi Rajpurkar; Rachel P Rosovsky; Suzan Williams; Anthony K C Chan; C Heleen van Ommen; E Vincent S Faustino; Melissa White; Mihir Parikh; Nongnuch Sirachainan; Tina Biss; Neil A Goldenberg

doi:10.1016/j.thromres.2024.02.019

Considerations for instituting pediatric pulmonary embolism response teams: A tool kit

Thromb Res. 2024 Apr:236:97-107. doi: 10.1016/j.thromres.2024.02.019. Epub 2024 Feb 22.

Authors

Affiliations

¹ Department of Pediatrics, Division of Pediatric Hematology Oncology, Central Michigan University, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA. Electronic address: rajpu1ma@cmich.edu.
² Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³ Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada.
⁴ McMaster Children's Hospital, McMaster University, Canada.
⁵ Department of Pediatric Hematology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
⁶ Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
⁷ Division of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁸ Department of Pediatric Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁹ Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
¹⁰ Department of Haematology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
¹¹ Department of Pediatrics and Medicine, Division of Hematology, Johns Hopkins, University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Institute for Clinical and Translational Research, Cancer and Blood Disorder Institute, and Heart Institute, Johns Hopkins All Children's, Hospital, St. Petersburg, FL, USA.

PMID: 38417301
DOI: 10.1016/j.thromres.2024.02.019

Abstract

The incidence of pediatric pulmonary embolism (PE) has increased by 200 % in the last decade, but at a single center, it is still infrequent. Given the unique epidemiologic features of pediatric PE, diagnosis is often delayed, and the management is empiric, based on individual physician experience or preference. Thus, there is a strong need for center-specific uniform management of pediatric PE patients. In adults, the development of pulmonary embolism response teams (PERTs) or PE critical care pathways has shortened the time to diagnosis and the initiation of definitive management. Evidence to support an improvement in PE outcomes after the development of PERTs does not exist in children. Nonetheless, we have summarized the practical practice guidelines that physicians and institutions can adopt to establish their institutional PERTs or critical pathways. We also provide strategies for resource-challenged institutions for partnering with centers with expertise in the management of pediatric PE.

Keywords: Critical pathways; Pediatrics; Pulmonary embolism.

MeSH terms

Adult
Child
Critical Care
Humans
Pulmonary Embolism* / diagnosis
Pulmonary Embolism* / therapy