Epidemiology of Bleeding in Critically Ill Children With an Underlying Oncologic Diagnosis

Romano, Juliana; Martínez, Mario; Levasseur, Julie; Killinger, James S.; Karam, Oliver; Nellis, Marianne

doi:10.1097/cce.0000000000000572

Cited by 3 publications

(4 citation statements)

References 30 publications

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“…However, the investigators used the WHO bleeding scale which may not be as relevant for critically ill patients (12). When comparing our study with a 2018 retrospective cohort similar to our population (7), using the BASIC definition, the finding of 9% experiencing at least one severe bleeding event during admission is similar.…”

Section: Discussionmentioning

confidence: 65%

“…Although bleeding has been described in the general PICU population, 2014-2020 (1)(2)(3), as well as during extracorporeal membrane oxygenation 2012-2020 (4)(5)(6), there are limited data focusing on bleeding and transfusion practices in critically ill children with malignancy. One retrospective cohort from 2018 reported that 9% of critically ill children with malignancy had severe bleeding (7). Children with cancer may be more vulnerable to bleeding events given frequent thrombocytopenia, chemotherapy, and radiation exposure, numerous procedures and surgeries, and reduced ability to recover from bleeding events secondary to bone marrow suppression.…”

Section: E603mentioning

confidence: 99%

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Bleeding in Critically Ill Children With Malignancy or Hematopoietic Cell Transplant: A Single-Center Prospective Cohort Study

Levasseur,

Fikse,

Mauguen

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To determine the incidence of bleeding in critically ill children with malignancy and to describe associated patient characteristics, interventions, and clinical outcomes. Design: Prospective cohort study. Setting: PICU in a specialized cancer hospital. Patients: Children with malignancy or hematopoietic cell transplant 0–18 years of age were admitted to the PICU from November 2020 to November 2021. Interventions: None. Measurements: Patient demographic data, laboratory values, and PICU outcome data were collected. Bleeding was classified according to the Bleeding Assessment Scale in Critically Ill Children. Main Results: Ninety-three bleeding patients were enrolled, and a total of 322 bleeding days were recorded. The median (interquartile range [IQR]) age was 5.8 (2.9–11.8) years and 56% (52/93) of the patients were male. There were 121 new bleeding episodes, in 593 at-risk person-days, translating into a 20% incidence rate per day (95% CI, 17–24%). The incidence of severe, moderate, and minimal bleeding was 2% (95% CI, 1–3), 4% (95% CI, 3–6), and 14% (95% CI, 12–17), respectively. Of the new bleeding episodes, 9% were severe, 25% were moderate and 66% were minimal. Thrombocytopenia was the only laboratory value independently associated with severe bleeding (p = 0.009), as compared to minimal and moderate bleeding episodes. History of radiation therapy was independently associated with severe bleeding (p = 0.04). We failed to identify an association between a history of stem cell transplant (p = 0.49) or tumor type (p = 0.76), and bleeding severity. Patients were transfused any blood product on 28% (95% CI, 22–34) of the bleeding days. Severe bleeding was associated with increased length of mechanical ventilation (p = 0.003), longer PICU stays (p = 0.03), and higher PICU mortality (p = 0.004). Conclusions: In this prospective cohort of children with malignancy, the incidence rate of bleeding was 20%. Most events were classified as minimal bleeding. Low platelet count and radiation therapy were variables independently associated with severe bleeding episodes.

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Section: Discussionmentioning

confidence: 65%

Section: E603mentioning

confidence: 99%

Bleeding in Critically Ill Children With Malignancy or Hematopoietic Cell Transplant: A Single-Center Prospective Cohort Study

Levasseur,

Fikse,

Mauguen

et al. 2023

Pediatric Critical Care Medicine

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“…Using the BASIC definition, our finding that severe bleeding in children following CPB is associated with poorer clinical outcomes mirrors that reported in a heterogenous prospective cohort of critically ill children, 16 as well as those with an underling oncologic diagnosis. 17 Previous studies, using a variety of definitions, have reported the rate of severe bleeding following cardiopulmonary bypass in children to range from 3 to 42%. 12 Various studies have concluded that younger age is associated with an increased risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiology of severe bleeding in children following cardiac surgery involving cardiopulmonary bypass: use of Bleeding Assessment Scale for critically Ill Children (BASIC)

et al. 2022

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Objectives: To describe the epidemiology of severe bleeding in the immediate post-operative period in children who undergo cardiopulmonary bypass surgery using the Bleeding Assessment Scale for critically Ill Children (BASIC). Study design: Retrospective cohort study in a paediatric ICU from 2015 to 2020. Results: 356 children were enrolled; 59% were male with median (IQR) age 2.1 (0.5–8) years. Fifty-seven patients (16%) had severe bleeding in the first 24 hours post-operatively. Severe bleeding was observed more frequently in younger and smaller children with longer bypass and cross-clamp times (p-values <0.001), in addition to higher surgical complexity (p = 0.048). Those with severe bleeding received significantly more red blood cells, platelets, plasma, and cryoprecipitate in the paediatric ICU following surgery (all p-values <0.001). No laboratory values obtained on paediatric ICU admission were able to predict severe post-operative bleeding. Those with severe bleeding had significantly less paediatric ICU-free days (p = 0.010) and mechanical ventilation-free days (p = 0.013) as compared to those without severe bleeding. Conclusions: Applying the BASIC definition to our cohort, severe bleeding occurred in 16% of children in the first day following cardiopulmonary bypass. Severe bleeding was associated with worse clinical outcomes. Standard laboratory assays do not predict bleeding warranting further study of available laboratory tests.

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Assessing the Reliability of the Bleeding Assessment Scale in Critically Ill Children (BASIC) Definition: A Prospective Cohort Study

Nellis,

Chegondi,

Willems

et al. 2024

Pediatric Critical Care Medicine

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Objectives: To determine the reliability of the Bleeding Assessment Scale in critically Ill Children (BASIC) definition of bleeding severity in a diverse cohort of critically ill children. Design: Prospective cohort study. Setting: Eight mixed PICUs in the Netherlands, Israel, and the United States. Subjects: Children ages 0–18 years admitted to participating PICUs from January 1, 2020, to December 31, 2022, with bleeding noted by bedside nurse. Interventions: None. Measurements and Main Results: The bleeding events were classified as minimal, moderate, or severe, according to the BASIC definition, by two independent physicians at two different time points. Patient demographic data, laboratory values, and clinical outcomes were collected. Three hundred twenty-eight patients were enrolled. The overall inter-rater reliability was substantial (weighted kappa coefficient, 0.736; 95% CI, 0.683–0.789), and the intra-rater reliability was “almost-perfect” (weighted kappa coefficient, 0.816; 95% CI, 0.769–0.863). The platelet count (p = 0.008), prothrombin time (p = 0.004), activated partial thromboplastin time (p = 0.025), and fibrinogen levels (p = 0.035) were associated with the bleeding severity, but the international normalized ratio was not (p = 0.195). Patients were transfused blood components in response to any bleeding in 31% of cases and received hemostatic medications in 9% of cases. More severe bleeding was associated with increased 28-day mortality, longer hospital length of stay, and more days receiving inotropic support. Conclusions: The BASIC definition is a reliable tool for identifying and classifying bleeding in critically ill children. Implementing this definition into clinical and research practice may provide a consistent and reliable evaluation of bleeding.

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Epidemiology of Bleeding in Critically Ill Children With an Underlying Oncologic Diagnosis

Abstract: Supplemental Digital Content is available in the text.

Cited by 3 publications

References 30 publications

Bleeding in Critically Ill Children With Malignancy or Hematopoietic Cell Transplant: A Single-Center Prospective Cohort Study

Bleeding in Critically Ill Children With Malignancy or Hematopoietic Cell Transplant: A Single-Center Prospective Cohort Study

Epidemiology of severe bleeding in children following cardiac surgery involving cardiopulmonary bypass: use of Bleeding Assessment Scale for critically Ill Children (BASIC)

Assessing the Reliability of the Bleeding Assessment Scale in Critically Ill Children (BASIC) Definition: A Prospective Cohort Study

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