PURPOSE: To estimate the incidence, severity, duration and consequences of bleeding during critical illness, and to test the performance characteristics of a new bleeding assessment tool. METHODS: Clinical bleeding assessments were performed prospectively on 100 consecutive patients admitted to a medical-surgical intensive care unit (ICU) using a novel bleeding measurement tool called HEmorrhage MEasurement (HEME). Bleeding assessments were done daily in duplicate and independently by blinded, trained assessors. Inter-rater agreement and construct validity of the HEME tool were calculated using phi. Risk factors for major bleeding were identified using a multivariable Cox proportional hazards model. RESULTS: Overall, 90% of patients experienced a total of 480 bleeds of which 94.8% were minor and 5.2% were major. Inter-rater reliability of the HEME tool was excellent (phi = 0.98, 95% CI: 0.96 to 0.99). A decrease in platelet count and a prolongation of partial thromboplastin time were independent risk factors for major bleeding but neither were renal failure nor prophylactic anticoagulation. Patients with major bleeding received more blood transfusions and had longer ICU stays compared to patients with minor or no bleeding. CONCLUSIONS: Bleeding, although primarily minor, occurred in the majority of ICU patients. One of five patients experienced a major bleed which was associated with abnormal coagulation tests but not with prophylactic anticoagulants. These baseline bleeding rates can inform the design of future clinical trials in critical care that use bleeding as an outcome and HEME is a useful tool to measure bleeding in critically ill patients.
PURPOSE: To estimate the incidence, severity, duration and consequences of bleeding during critical illness, and to test the performance characteristics of a new bleeding assessment tool. METHODS: Clinical bleeding assessments were performed prospectively on 100 consecutive patients admitted to a medical-surgical intensive care unit (ICU) using a novel bleeding measurement tool called HEmorrhage MEasurement (HEME). Bleeding assessments were done daily in duplicate and independently by blinded, trained assessors. Inter-rater agreement and construct validity of the HEME tool were calculated using phi. Risk factors for major bleeding were identified using a multivariable Cox proportional hazards model. RESULTS: Overall, 90% of patients experienced a total of 480 bleeds of which 94.8% were minor and 5.2% were major. Inter-rater reliability of the HEME tool was excellent (phi = 0.98, 95% CI: 0.96 to 0.99). A decrease in platelet count and a prolongation of partial thromboplastin time were independent risk factors for major bleeding but neither were renal failure nor prophylactic anticoagulation. Patients with major bleeding received more blood transfusions and had longer ICU stays compared to patients with minor or no bleeding. CONCLUSIONS:Bleeding, although primarily minor, occurred in the majority of ICU patients. One of five patients experienced a major bleed which was associated with abnormal coagulation tests but not with prophylactic anticoagulants. These baseline bleeding rates can inform the design of future clinical trials in critical care that use bleeding as an outcome and HEME is a useful tool to measure bleeding in critically illpatients.
Authors: Susan R Kahn; Wendy Lim; Andrew S Dunn; Mary Cushman; Francesco Dentali; Elie A Akl; Deborah J Cook; Alex A Balekian; Russell C Klein; Hoang Le; Sam Schulman; M Hassan Murad Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: Marianne E Nellis; Marisa Tucci; Jacques Lacroix; Philip C Spinella; Kelly D Haque; Arabela Stock; Marie E Steiner; E Vincent S Faustino; Nicole D Zantek; Peter J Davis; Simon J Stanworth; Jill M Cholette; Robert I Parker; Pierre Demaret; Martin C J Kneyber; Robert T Russell; Paul A Stricker; Adam M Vogel; Ariane Willems; Cassandra D Josephson; Naomi L C Luban; Laura L Loftis; Stéphane Leteurtre; Christian F Stocker; Susan M Goobie; Oliver Karam Journal: Crit Care Med Date: 2019-12 Impact factor: 7.598
Authors: Pablo García-Olivares; Jose Eugenio Guerrero; Pedro Galdos; Demetrio Carriedo; Francisco Murillo; Antonio Rivera Journal: Intensive Care Med Date: 2014-08-20 Impact factor: 17.440
Authors: K M Sauro; A Soo; A Kramer; P Couillard; J Kromm; D Zygun; D J Niven; S M Bagshaw; H T Stelfox Journal: Neurocrit Care Date: 2019-04 Impact factor: 3.210
Authors: C Neunert; N Noroozi; G Norman; G R Buchanan; J Goy; I Nazi; J G Kelton; D M Arnold Journal: J Thromb Haemost Date: 2015-01-14 Impact factor: 5.824
Authors: Steven L Spitalnik; Darrell Triulzi; Dana V Devine; Walter H Dzik; Anne F Eder; Terry Gernsheimer; Cassandra D Josephson; Daryl J Kor; Naomi L C Luban; Nareg H Roubinian; Traci Mondoro; Lisbeth A Welniak; Shimian Zou; Simone Glynn Journal: Transfusion Date: 2015-08-10 Impact factor: 3.157
Authors: François Lauzier; Donald M Arnold; Christian Rabbat; Diane Heels-Ansdell; Ryan Zarychanski; Peter Dodek; Betty Jean Ashley; Martin Albert; Kosar Khwaja; Marlies Ostermann; Yoanna Skrobik; Robert Fowler; Lauralyn McIntyre; Joseph L Nates; Tim Karachi; Renato D Lopes; Nicole Zytaruk; Simon Finfer; Mark Crowther; Deborah Cook Journal: Intensive Care Med Date: 2013-08-14 Impact factor: 17.440