Pulmonary embolism (PE) in children may be far more common than once believed, according to new research presented at the ATS 2025 International Conference. A large, prospective study has found that the rate of PE in pediatric patients presenting with suspicious symptoms is comparable to that in adults—challenging long-standing assumptions in pediatric care.
The study, part of the BEEPER (BEdside Exclusion of Pulmonary Embolism in children without the need for Radiation) multicenter project, involved 4,011 children aged 4 to 17 who were evaluated at 21 emergency departments across the United States for symptoms suggestive of PE.
Researchers found that 6.3% of these children were diagnosed with acute PE. Of those, 3.0% had PE alone, 1.8% had deep vein thrombosis (DVT), and 1.3% had both conditions.
“This is the first prospective study of its kind and it shows that PE in children is not nearly as rare as previously believed,” said Dr. Jeffrey Kline, a lead investigator in the study. Earlier retrospective data had estimated pediatric PE rates at fewer than 1 in 100,000 annually.
Perhaps more surprising than the numbers, Kline said, were the similarities between pediatric and adult cases. “The clinical features that help identify PE in children mirror those seen in adults,” he noted.
The study also offers clinicians the first evidence-based criteria to help determine when to begin a diagnostic workup for suspected PE in children. This framework aims to identify high-risk cases while minimizing unnecessary radiation exposure from imaging tests.
Nearly 80% of the children in the study received a D-dimer test, a blood test used to detect blood clots. When further testing was needed, physicians used computed tomographic pulmonary angiography (CTPA), VQ scans, MRI, and venous ultrasound.
Kline said the findings raise important questions about pediatric care. “Do children commonly experience undiagnosed PE and recover without long-term effects? Or are we missing early opportunities to treat a condition that could lead to chronic complications or, in rare cases, sudden death?”
The research team plans to follow up with a new multicenter study to assess whether clinical guidelines can safely reduce unnecessary testing while improving diagnosis in children suspected of having PE.
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