Septic pulmonary embolism in Somali children: a retrospective study from a tertiary hospital

Abstract

Background Septic pulmonary embolism (SPE) is an under-recognized cause of severe infection in children, particularly in low-resource settings. Evidence from Somalia is absent, despite high rates of skin and soft-tissue infection and limited diagnostic capacity. This study described the clinical characteristics, microbiology, radiological features, management, and outcomes of pediatric SPE in a Somali tertiary hospital. Methods We conducted a retrospective review of children aged < 18 years diagnosed with SPE between 2021 and 2025. Data on demographics, clinical presentation, laboratory parameters, radiological findings, microbial isolates, treatments, and outcomes were extracted. Continuous variables were summarized as mean ± SD or median (IQR) and categorical variables as counts and percentages. ICU and non-ICU groups were compared using t -tests or Mann–Whitney U tests and Fisher's exact test where appropriate. Effect sizes (Cohen's d, rank-biserial correlation) were calculated. Due to the small number of events and absence of mortality, no multivariable modelling was performed. Results Fifteen children met diagnostic criteria for SPE; median age was 12 years and 80% were male. Skin and soft-tissue infections, trauma-related sepsis, and septic thrombophlebitis were the most common sources. Staphylococcus aureus (MSSA/MRSA) accounted for most culture-positive cases while coagulase-negative staphylococci and Gram-negative organisms were less frequent. Radiological findings included peripheral nodules, cavitation, and pleural disease. Five children (33%) required ICU admission and anticoagulation was used in 93%. ICU patients were younger, had higher inflammatory markers and experienced significantly longer hospital stays ( p = 0.031; d = 1.49). No in-hospital deaths occurred. Conclusion Pediatric SPE in Somalia is predominantly staphylococcal in origin and commonly arises from skin, soft-tissue, or trauma-related infections. Despite limited imaging and microbiology resources, characteristic radiological patterns and marked inflammation facilitate diagnosis. Younger age, higher leukocytosis, and prolonged hospitalization were associated with ICU admission, but overall outcomes were favorable with timely antimicrobial therapy, anticoagulation, and procedural interventions. These findings provide urgently needed baseline evidence for SPE in Somali children and underscore the importance of early recognition in resource-limited settings.