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Bleeding Scales Applicable to Critically Ill Children: A Systematic Review

Nellis, Marianne E. MD, MS1; Levasseur, Julie MD1; Stribling, Judy2; Faustino, E. Vincent S. MD3; Zantek, Nicole D. MD4; Sheth, Sujit MD5; Karam, Oliver MD, PhD6

Pediatric Critical Care Medicine: July 2019 - Volume 20 - Issue 7 - p 603-607
doi: 10.1097/PCC.0000000000001943
Feature Review Article

Objectives: To summarize current bleeding scales and their validation to assess applicability to bleeding in critically ill children.

Data Sources: We conducted electronic searches of Ovid MEDLINE, Ovid EMBASE, Cochrane Library, and Web of Science Core Collection databases from database inception to 2017.

Study Selection: Included studies contained a bleeding score, bleeding measurement tool, or clinical measurement of hemorrhage.

Data Extraction: We identified 2,097 unique citations; 20 full-text articles were included in the final review.

Data Synthesis: Of the 18 studies that included subjects (two others were expert consensus definitions), seven (39%) were pediatric-only, seven (39%) were adult-only, and four (22%) included both adults and children. Nine (50%) occurred with inpatients (two studies in critical care units), seven (39%) involved outpatients and two (11%) included both inpatients and outpatients. Thirty-nine percent of the scales were developed for those with idiopathic thrombocytopenic purpura and only two (12%) described critically ill patients. The majority (80%) included need for treatment (either RBC transfusion or surgical intervention). The majority (65%) did not report measures of reliability or validation to clinical outcomes.

Conclusions: There is a lack of validated bleeding scales to adequately assess bleeding and outcomes in critically ill children. Validated scales of bleeding are necessary and urgently needed.

1Pediatric Critical Care Medicine, Department of Pediatrics, New York Presbyterian Hospital - Weill Cornell Medicine, New York, NY.

2Samuel J. Wood Library - Weill Cornell Medicine, New York, NY.

3Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT.

4Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN.

5Division of Pediatric Hematology/Oncology, Department of Pediatrics, New York Presbyterian Hospital - Weill Cornell Medicine, New York, NY.

6Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.

*See also p. 674.

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Dr. Zantek received research funding from Octapharma, Bayer HealthCare, Terumo BCT, and she disclosed that she is an executive board member of North American Specialized Coagulation Laboratory, and her husband is an employee of Boston Scientific and has a financial interest in ENDO International PLC. Dr. Sheth received funding from Celgene (related to Luspatercept), Novartis (related to deferasirox), Apopharma (related to deferiprone), and Bluebird Bio (related to lentiglobin therapies). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies