PULMONARY embolism in children may be more prevalent than previously recognized according to new findings from a large prospective multicenter study conducted across 21 pediatric emergency departments in the United States. The BEEPER (BEdside Exclusion of Pulmonary Embolism in children without need for Radiation) study, the first of its kind to examine the prospective diagnosis of pulmonary embolism (PE) in children, enrolled 4,103 children aged 4 to 17 who presented with symptoms prompting evaluation for PE.
The results, now available from data adjudicated for 3,663 of those participants, reveal that 4.2% were diagnosed with PE or deep vein thrombosis (DVT), a rate significantly higher than the long-standing estimate of less than 1 in 100,000 children per year. Among these, 2.1% had isolated PE, 1.1% had isolated DVT, and 1.0% had both.
These findings may shift clinical perceptions, as the data mirrors adult diagnostic patterns in emergency settings. The average age of affected children was 15 years, slightly older than the mean age of the cohort (14 years), with nearly two-thirds of participants being female. Diagnostic strategies largely relied on D-dimer tests, which were used in nearly 80% of cases. Computed tomographic pulmonary angiography (CTPA) was performed in 34.6% of children, with a positivity rate of 10.4%, while other modalities such as VQ scans, MRI, and venous ultrasound also demonstrated notable diagnostic yields.
This study represents the first national-scale prospective effort to define the epidemiology and diagnostic landscape of PE in children. The findings not only call into question existing assumptions about pediatric PE prevalence but also emphasize the importance of heightened clinical suspicion and appropriate testing strategies in children presenting with compatible symptoms.
Reference:
Kline JA et al. High Frequency of Pulmonary Embolism in Symptomatic Children in the Emergency Department. Am J Respir Crit Care Med. 2025;211:A7102.
