Bleeding Assessment Scale in Critically Ill Children (BASIC): Physician-Driven Diagnostic Criteria for Bleeding Severity.

Autor:	Nellis ME; Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY., Tucci M; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, QC, Canada., Lacroix J; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, QC, Canada., Spinella PC; Division of Critical Care Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, MO., Haque KD; Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY., Stock A; Division of Pediatric Cardiology, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY., Steiner ME; Divisions of Critical Care and Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN., Faustino EVS; Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT., Zantek ND; Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN., Davis PJ; Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom., Stanworth SJ, Cholette JM; Divisions of Critical Care and Cardiology, Department of Pediatrics, University of Rochester, Golisano Children's Hospital, Rochester, NY., Parker RI; Emeritus Department of Pediatrics, Division of Hematology/Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY., Demaret P; Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Liège, Belgium., Kneyber MCJ; Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Russell RT; Department of Pediatric Surgery, Children's Hospital of Alabama, Birmingham, AL., Stricker PA; General Anesthesiology Division, Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA., Vogel AM; Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX., Willems A; Division of Pediatric Intensive Care, Department of Intensive Care, Leiden Universitair Medisch Centrum, Leiden, The Netherlands., Josephson CD; Departments of Pathology and Pediatrics, Emory University School of Medicine and the Center for Transfusion and Cellular Therapies, Atlanta, GA., Luban NLC; Departments of Pediatrics and Pathology, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC., Loftis LL; Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX., Leteurtre S; Université de Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France., Stocker CF; Department of Pediatrics, Queensland Children's Hospital, Brisbane, Australia., Goobie SM; Department of Anesthesiology, Critical Care & Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA., Karam O; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2019 Dec; Vol. 47 (12), pp. 1766-1772.
DOI:	10.1097/CCM.0000000000004025
Abstrakt:	Objective: Although 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. Design: Delphi consensus process of multidisciplinary experts in bleeding/hemostasis in critically ill children, followed by prospective cohort study to test internal validity. Setting: PICU. Patients: Children at risk of bleeding in PICUs. Interventions: None. Measurements and Main Results: Twenty-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. Conclusions: The 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.
Databáze:	MEDLINE
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