BackgroundThe incidence of pediatric pulmonary embolism is increasing, with varying clinical characteristics, severity, and prognosis. Compared with data from adults, data and knowledge regarding the prognosis of pediatric pulmonary embolism are scarce. This study aims to study the overall prognosis of pediatric pulmonary embolism and explore its influencing factors.MethodsThe study included patients diagnosed with pulmonary embolism aged 1-18 years across eight tertiary referral hospitals from January 1, 2003, to December 31, 2023. Pulmonary embolism was diagnosed on the basis of clinical presentation with imaging evidence. The overall prognosis of children with pulmonary embolism was reported, and its influencing factors were analyzed.ResultsA total of 196 children were enrolled, with a median age of 11.8 (7.9, 15.4) years, 113 males (58%) and 186 Han (95%). The overall mortality rates were 2.2% at 30 days, 3.4% at 90 days, and 5.1% during the entire follow-up period. The pulmonary embolism-related mortality rates were 1.6% (30 days), 2.7% (90 days), and 2.6% (entire follow-up period). Deep vein thrombosis at other sites occurred in 2.7% (30 days), 4.1% (90 days), and 7.6% (entire follow-up period) of the children. Among the 148 children who underwent repeat imaging examinations, 119 (81%) achieved complete remission; 24 (16%) achieved partial remission; and 4 (3%) experienced recurrence or progression during the follow-up period. Multivariable logistic regression analysis revealed that tachypnea, co-infection, and underlying disease of the tumor were independent risk factors for compound adverse events (death, pulmonary embolism progression/recurrence, and at other sites) within 90 days.ConclusionsThe short-term mortality of children with pulmonary embolism was relatively low. Children with pulmonary embolism who had tachypnea, co-infection, or underlying disease of the tumor were at increased risk of compound adverse events within 90 days.