Post pulmonary embolism syndrome showed a high prevalence in children, occurring in 35% at 3 months, 24% at 1 year, and 16% at 2 years, with incomplete thrombus resolution, PICU admission, intermediate/high-risk PE, comorbidity, ongoing treatment, and psychological distress identified as clinical factors associated with physical limitations.
Key Findings
Results
Post pulmonary embolism syndrome (PPES) was highly prevalent in children following pulmonary embolism, affecting 35% at 3 months, 24% at 1 year, and 16% at 2 years.
63 of 178 patients (35%) developed PPES at 3 months post pulmonary embolism
41 of 168 patients (24%) had PPES at 1 year follow-up
25 of 161 patients (16%) had PPES at 2 years follow-up
Overall, 63 (35%) patients developed PPES within 2 years, while 115 (65%) did not
Follow-up completion was high: 100% at 3 months, 94% at 1 year, and 93% at 2 years
Results
Incomplete thrombus resolution was significantly associated with physical limitations at 1 year post pulmonary embolism.
Odds ratio 3.8 (95% CI 1.4–10.3), p=0.0090
This was identified through multivariate analysis with confounders determined using directed acyclic graph methodology
Physical restriction at 1 year post pulmonary embolism was the secondary outcome measure
Results
Intermediate-risk or high-risk pulmonary embolism classification was the strongest clinical factor associated with physical limitations at 1 year.
Odds ratio 4.1 (95% CI 1.8–9.4), p=0.0010
This was among the highest odds ratios of all factors examined
Identified via multivariate analysis adjusting for confounders
Results
Psychological distress at 3 months post pulmonary embolism was strongly associated with physical limitations at 1 year.
Odds ratio 4.3 (95% CI 1.9–9.8), p=0.0010
This was the highest odds ratio among all identified clinical factors
Findings emphasise the need for comprehensive, multidisciplinary care including psychological support
Results
PICU admission was independently associated with physical limitations at 1 year post pulmonary embolism.
Odds ratio 2.8 (95% CI 1.2–7.6), p=0.017
Identified as one of six clinical factors associated with physical restriction at 1 year
Multivariate analysis was used to control for confounders
Results
Presence of comorbidity and ongoing anticoagulation treatment were each associated with physical limitations at 1 year.
Comorbidity: OR 2.9 (95% CI 1.3–6.4), p=0.010
Ongoing treatment: OR 2.8 (95% CI 1.2–6.5), p=0.016
Both factors were identified in the same multivariate analysis framework
Results
Regular exercise at least 3 times per week was inversely associated with physical limitations at 1 year post pulmonary embolism.
Odds ratio 0.31 (95% CI 0.1–0.8), p=0.0090
This was the only factor identified as protective against physical limitations
Identified through the same multivariate analysis as the risk factors
Methods
The study cohort consisted predominantly of adolescent female patients treated at six tertiary paediatric hospitals in the Netherlands from 2012 to 2022.
183 patients were initially eligible; 178 were included after exclusions (4 for insufficient follow-up data, 1 death)
115 (65%) were female and 63 (35%) were male
Median age was 15.0 years (IQR 13.0–16.0)
This was a multicentre, retrospective cohort study
What This Means
This research suggests that a significant proportion of children who experience a pulmonary embolism (a blood clot in the lungs) go on to develop 'post pulmonary embolism syndrome' (PPES) — a condition involving ongoing physical and psychological difficulties after the initial clot. Studying 178 children treated at six Dutch hospitals over a decade, the researchers found that 35% had PPES at 3 months after their clot, dropping to 24% at 1 year and 16% at 2 years. This indicates that while many children improve over time, a meaningful number continue to experience lasting effects.
The study identified several factors that increased the likelihood of physical limitations one year after the pulmonary embolism. Children who had more severe clots (classified as intermediate or high risk), were admitted to intensive care, had other health conditions, still needed treatment at follow-up, had incomplete resolution of their clot, or experienced psychological distress at 3 months were all more likely to have physical limitations at 1 year. Notably, psychological distress and PE severity had the strongest associations. On the positive side, children who exercised at least three times per week were significantly less likely to have physical limitations.
This research suggests that recovery from childhood pulmonary embolism is not just a physical process — psychological wellbeing and activity levels also play important roles. The findings point to the value of comprehensive, multidisciplinary follow-up care for children after a pulmonary embolism, incorporating both physical and psychological support, rather than focusing solely on the clot itself.
Verweij M, van Ommen C, Diender M, Jongmans-van der Heide A, Hovinga I, Rettenbacher E, et al.. (2026). Post pulmonary embolism syndrome following paediatric pulmonary embolism: a multicentre, retrospective cohort study.. The Lancet. Haematology. https://doi.org/10.1016/S2352-3026(26)00071-2