systematic review of clinical decision rules used for diagnosing pulmonary embolism in the pediatric opulation

Objective: This review aims to evaluate the diagnostic accuracy of existing, adult clinical decision tools for pulmonary embolism, in the pediatric population. Methods: A systematic search and screening of the Pubmed, Embase, CINAHL, and Cochrane databases was done in January 2018. Studies evaluating the diagnostic accuracy of clinical decision tools and/or risk factors and clinical features for pulmonary embolism in the pediatric population were included. The measures of diagnostic accuracy of clinical decision tools were calculated. The pooled sensitivity and specificity of risk factors were calculated using a bivariate random effects model. All included studies were assessed for quality using QUADAS-2. Results: Six studies were included: three case-control and three retrospective cohort studies. We found that no standard clinical decision tool for pulmonary embolism has been evaluated in the pediatric population. As well, adult clinical decision tools have low diagnostic utility in pediatrics. Conclusion: Adult clinical decision tools should not be used for pediatric patients. There was no single risk factor or clinical feature displaying reliable sensitivity; however, a central venous line, a recent surgery, or the finding of hemoptysis, all have a positive likelihood ratio greater than two, demonstrating their potential diagnostic utility. Large, prospective cohort studies are needed.