A multi-institutional study including researchers from Children’s Hospital of Philadelphia (CHOP) is the first prospective investigation to characterize how Pulmonary Embolism (PE) presents in children and evaluate a bedside clinical decision rule for identifying children at very low risk of the condition. The findings – which revealed a higher prevalence of venous thromboembolism among children than what was expected – were recently published in the journal The Lancet Respiratory Medicine.
A potentially life-threatening condition caused by a blood clot traveling to the lungs, PE is uncommon in children and can be difficult to diagnose. Until now, clinicians have had little prospective evidence to guide decisions about which children require testing and which can safely avoid radiation-based imaging. While validated clinical decision rules exist for adults, no prospective tool had been developed to help rule out PE in children.
That evidence gap is now addressed by the multicenter Bedside Exclusion of Pulmonary Embolism Without Use of Radiation in Children (BEEPER) study, which enrolled more than 4,000 children with suspected PE across 21 pediatric emergency departments in the United States between 2020 and 2024.
Researchers analyzed data from 3,988 children with complete follow-up and monitored participants for 45 days to determine whether they developed PE or proximal deep vein thrombosis. Overall, 253 children (6.3%) were diagnosed with venous thromboembolism – a prevalence that was higher than expected and comparable to that seen in adults undergoing evaluation for PE.
The study prospectively evaluated the Pulmonary Embolism Rule-out Criteria for Children (PERC-Peds), a bedside clinical decision rule based on eight readily available clinical features that can be assessed without laboratory testing or imaging. Among the 734 children who met all PERC-Peds criteria, only one was ultimately diagnosed with PE or proximal deep vein thrombosis, demonstrating a sensitivity of 99.6% and a false-negative rate of just 0.1%.
“If a child is PERC-Peds negative, the likelihood of actually having pulmonary embolism is extremely low,” said Angela Ellison, MD, MSc, professor and Vice Chair of Pediatrics at Children's Hospital of Philadelphia and co-principal investigator of the study. “These findings suggest that PERC-Peds can help clinicians safely reduce unnecessary radiation exposure while maintaining an exceptionally low risk of missing clinically important blood clots.”
The findings provide the first prospective evidence supporting the use of a validated clinical decision rule to safely identify children at very low risk for PE, offering clinicians an important new tool to improve care while reducing unnecessary imaging.
This study was support by National Heart, Lung, and Blood Institute grant R01HL148247.
Ellison et al. PERC-Peds rule for bedside exclusion of pulmonary embolism without radiation in children in the USA (BEEPER): a multicentre, prospective, observational, diagnostic accuracy study. Lancet Respir Med. Online July 3, 2026. DOI: 10.1016/S2213-2600(26)00086-X.
Read more from the news release from Wayne State University.
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A multi-institutional study including researchers from Children’s Hospital of Philadelphia (CHOP) is the first prospective investigation to characterize how Pulmonary Embolism (PE) presents in children and evaluate a bedside clinical decision rule for identifying children at very low risk of the condition. The findings – which revealed a higher prevalence of venous thromboembolism among children than what was expected – were recently published in the journal The Lancet Respiratory Medicine.
A potentially life-threatening condition caused by a blood clot traveling to the lungs, PE is uncommon in children and can be difficult to diagnose. Until now, clinicians have had little prospective evidence to guide decisions about which children require testing and which can safely avoid radiation-based imaging. While validated clinical decision rules exist for adults, no prospective tool had been developed to help rule out PE in children.
That evidence gap is now addressed by the multicenter Bedside Exclusion of Pulmonary Embolism Without Use of Radiation in Children (BEEPER) study, which enrolled more than 4,000 children with suspected PE across 21 pediatric emergency departments in the United States between 2020 and 2024.
Researchers analyzed data from 3,988 children with complete follow-up and monitored participants for 45 days to determine whether they developed PE or proximal deep vein thrombosis. Overall, 253 children (6.3%) were diagnosed with venous thromboembolism – a prevalence that was higher than expected and comparable to that seen in adults undergoing evaluation for PE.
The study prospectively evaluated the Pulmonary Embolism Rule-out Criteria for Children (PERC-Peds), a bedside clinical decision rule based on eight readily available clinical features that can be assessed without laboratory testing or imaging. Among the 734 children who met all PERC-Peds criteria, only one was ultimately diagnosed with PE or proximal deep vein thrombosis, demonstrating a sensitivity of 99.6% and a false-negative rate of just 0.1%.
“If a child is PERC-Peds negative, the likelihood of actually having pulmonary embolism is extremely low,” said Angela Ellison, MD, MSc, professor and Vice Chair of Pediatrics at Children's Hospital of Philadelphia and co-principal investigator of the study. “These findings suggest that PERC-Peds can help clinicians safely reduce unnecessary radiation exposure while maintaining an exceptionally low risk of missing clinically important blood clots.”
The findings provide the first prospective evidence supporting the use of a validated clinical decision rule to safely identify children at very low risk for PE, offering clinicians an important new tool to improve care while reducing unnecessary imaging.
This study was support by National Heart, Lung, and Blood Institute grant R01HL148247.
Ellison et al. PERC-Peds rule for bedside exclusion of pulmonary embolism without radiation in children in the USA (BEEPER): a multicentre, prospective, observational, diagnostic accuracy study. Lancet Respir Med. Online July 3, 2026. DOI: 10.1016/S2213-2600(26)00086-X.
Read more from the news release from Wayne State University.
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