Pulmonary embolism in children, while thought to be rare, has been acknowledged as an issue in clinical care. New research led by Wayne State University School of Medicine Department of Emergency Medicine Professor and Associate Chair of Research Jeffrey Kline, M.D., shows it is more common than previously understood.
Dr. Kline presented the results of a multi-center study at the American Thoracic Society’s 2025 International Conference on May 20 in San Francisco, detailing an unexpectedly high frequency of pulmonary embolism in pediatric patients — equal to rates seen in adults. It’s the first study to examine rates of pulmonary embolism in children.
“High Frequency of Pulmonary Embolism in Symptomatic Children in the Emergency Department” is published in the American Journal of Respiratory and Critical Care Medicine.
A life-threatening condition, pulmonary embolism occurs when a blood clot blocks one of the arteries in the lungs, preventing blood flow and leading to reduced oxygen levels and potential damage to lung tissue.
“I have studied pulmonary embolism diagnosis for years, and knew from years of experience with medical malpractice cases as an expert witness, as well as first-hand experience in the pediatric emergency department, that the condition often goes under-diagnosed,” Dr. Kline said.
Previous studies using patient databases suggested the condition occurred in fewer than one in 100,000 children per year. The new study found that as many as 6.3% of children who present with suspicious symptoms may be diagnosed with acute pulmonary embolism.
The abstract presented by Dr. Kline provides the first data to be released from BEdside Exclusion of Pulmonary Embolism in children without the need for Radiation, or BEEPER, a multi-center study of which he is the principal investigator.
The study involved 4,011 children ranging from 4 to 17 years old presenting at 21 emergency departments in the United States with symptoms suggesting evaluation for the condition.
Further testing found that 3% of the children had pulmonary embolism alone; 1.8% had deep vein thrombosis; and 1.3% had both. Dr. Kline noted that the patterns that helped distinguish the condition in children were akin to those also recognized in adults.
The study will help guide clinicians who suspect the condition in children to begin a diagnostic workup. The work also provides an evidence-based approach to testing in children who would have gone undiagnosed, also reducing low-value exposure to radiation, Dr. Kline said.
Nearly 80% of the patients received a D-dimer test as the initial diagnostic test, a blood test that can detect markers of blood clots. Other imaging tests were used to make the diagnosis, including computed tomographic pulmonary angiography, ventilation perfusion lung scan, magnetic resonance imaging and venous ultrasound.
Dr. Kline said the results raised important questions.
“This is the most thought-provoking part of our findings,” he said. “Do children experience PE commonly and remain undiagnosed, but then recover without sequela? Or are we missing the opportunity to intervene earlier on an unrecognized cause of pulmonary hypertension or other chronic disability or rarely, cause of sudden death?”
The researchers will now investigate whether new guidelines help safely rule out pulmonary embolism in children without unnecessary tests.
The work is supported by grant R01HL148247 to Dr. Kline from the National Heart, Lung and Blood Institute of the National Institutes of Health.