Pulmonary embolism in adolescents

SJH Emergency Medicine
NHS Lothian

Objectives

This guideline deals with the Investigation of adolescents with suspected pulmonary embolism.

In adolescents (13-16)  with otherwise unexplained* shortness of breath, pleuritic chest pain or haemoptysis, a pulmonary embolus is extremely unlikely if there are no ‘signs’ or ‘risk factors’ (see below). No further investigation is required – provide safety netting advice to return if any deterioration in condition.

* beware attributing shortness of breath to anxiety if any risk factors (see below) are present – discuss with senior

Risk factors in suspected pulmonary embolism in adolescents

Signs

  • Heart rate consistently >100 beats/min
  • Respiratory rate consistently >22 breaths/min
  • SaO2 consistently <94% on air
  • Limb swelling

Red risk factors

  • Recent major surgery
  • Active cancer
  • Limb immobility (including lower limb cast)
  • Central line in place or recently removed
  • Prior unprovoked VTE (venous thromboembolism)
  • Prior provoked VTE with ongoing risk factor

Non-red risk factors

  • Prior provoked VTE with no ongoing risk factor
  • Family history (first degree relative) of VTE
  • Oral contraceptive use
  • Pregnancy
  • Acute or chronic inflammatory condition
  • Obesity

 

Further investigations

A d-dimer should only be performed if there is a non-red risk factor with no signs.

A CTPA should be performed if:

  • There is any sign
  • There is a red risk factor
  • D-dimer is elevated (see above)

 

Editorial Information

Last reviewed: 21/08/2024

Next review date: 21/08/2026

Author(s): Alexis Leal.

Author email(s): alexis.leal@nhs.scot.

Reviewer name(s): Alexis Leal, Deepankar Datta.

Evidence method

Based on guidelines for CYP and SJH developed after a SAE in 2019