• Marianne E Nellis, Marisa Tucci, Jacques Lacroix, Philip C Spinella, Kelly D Haque, Arabela Stock, Marie E Steiner, Faustino E Vincent S EVS Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT., Nicole D Zantek, Peter J Davis, Simon J Stanworth, Jill M Cholette, Robert I Parker, Pierre Demaret, Kneyber Martin C J MCJ Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Univers, Robert T Russell, Paul A Stricker, Adam M Vogel, Ariane Willems, Cassandra D Josephson, Luban Naomi L C NLC Departments of Pediatrics and Pathology, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washi, Laura L Loftis, Stéphane Leteurtre, Christian F Stocker, Susan M Goobie, Oliver Karam, and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network; and the Pediatric Critical Care Blood Research Network (BloodNet).
• Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY.
• Crit. Care Med. 2019 Dec 1; 47 (12): 1766-1772.

ObjectiveAlthough bleeding frequently occurs in critical illness, no published definition to date describes the severity of bleeding accurately in critically ill children. We sought to develop diagnostic criteria for bleeding severity in critically ill children.DesignDelphi consensus process of multidisciplinary experts in bleeding/hemostasis in critically ill children, followed by prospective cohort study to test internal validity.SettingPICU.PatientsChildren at risk of bleeding in PICUs.InterventionsNone.Measurements And Main ResultsTwenty-four physicians worldwide (10 on a steering committee and 14 on an expert committee) from disciplines related to bleeding participated in development of a definition for clinically relevant bleeding. A provisional definition was created from 35 descriptors of bleeding. Using a modified online Delphi process and conference calls, the final definition resulted after seven rounds of voting. The Bleeding Assessment Scale in Critically Ill Children definition categorizes bleeding into severe, moderate, and minimal, using organ dysfunction, proportional changes in vital signs, anemia, and quantifiable bleeding. The criteria do not include treatments such as red cell transfusion or surgical interventions performed in response to the bleed. The definition was prospectively applied to 40 critically ill children with 46 distinct bleeding episodes. The kappa statistic between the two observers was 0.74 (95% CI, 0.57-0.91) representing substantial inter-rater reliability.ConclusionsThe Bleeding Assessment Scale in Critically Ill Children definition of clinically relevant bleeding severity is the first physician-driven definition applicable for bleeding in critically ill children derived via international expert consensus. The Bleeding Assessment Scale in Critically Ill Children definition includes clear criteria for bleeding severity in critically ill children. We anticipate that it will facilitate clinical communication among pediatric intensivists pertaining to bleeding and serve in the design of future epidemiologic studies if it is validated with patient outcomes.

14 keywords...

hide…