OBJECTIVE: To determine the epidemiology of bleeding in critically ill children. STUDY DESIGN: We conducted a cohort study of children <18 years old admitted to the pediatric intensive care unit for >24 hours and without clinically relevant bleed (CRB) on admission. CRB was defined as resulting in severe physiologic derangements, occurring at a critical site or requiring major therapeutic interventions. Using a novel bleeding assessment tool that we developed, characteristics of the CRB were abstracted from the medical records independently and in duplicate. From the cohort, we matched each child with CRB to 4 children without CRB based on onset of CRB. Risk factors and complications of CRB were identified from this matched group of children. RESULTS: We analyzed 405 children with a median age of 35 months (IQR 7-130 months). A total of 37 (9.1%) children developed CRB. The median number of days with CRB was 1 day (IQR 1-2 days). Invasive ventilation (OR 61.35; 95% CI 6.27-600.24), stress ulcer prophylaxis (OR 2.70; 95% CI 1.08-6.74), surgical admission (OR 0.29; 95% CI 0.10-0.84), and aspirin (OR 0.04; 95% CI 0.002-0.58) were associated with CRB. CRB was associated with longer time to discharge from the unit (hazard ratio 0.20; 95% CI 0.13-0.33) and the hospital (hazard ratio 0.49; 95% CI 0.33-0.73). Children with CRB were on vasopressor longer and transfused more red blood cells after the CRB than those without CRB. CONCLUSIONS: Our findings suggest that bleeding complicates critical illness in children.
OBJECTIVE: To determine the epidemiology of bleeding in critically ill children. STUDY DESIGN: We conducted a cohort study of children <18 years old admitted to the pediatric intensive care unit for >24 hours and without clinically relevant bleed (CRB) on admission. CRB was defined as resulting in severe physiologic derangements, occurring at a critical site or requiring major therapeutic interventions. Using a novel bleeding assessment tool that we developed, characteristics of the CRB were abstracted from the medical records independently and in duplicate. From the cohort, we matched each child with CRB to 4 children without CRB based on onset of CRB. Risk factors and complications of CRB were identified from this matched group of children. RESULTS: We analyzed 405 children with a median age of 35 months (IQR 7-130 months). A total of 37 (9.1%) children developed CRB. The median number of days with CRB was 1 day (IQR 1-2 days). Invasive ventilation (OR 61.35; 95% CI 6.27-600.24), stress ulcer prophylaxis (OR 2.70; 95% CI 1.08-6.74), surgical admission (OR 0.29; 95% CI 0.10-0.84), and aspirin (OR 0.04; 95% CI 0.002-0.58) were associated with CRB. CRB was associated with longer time to discharge from the unit (hazard ratio 0.20; 95% CI 0.13-0.33) and the hospital (hazard ratio 0.49; 95% CI 0.33-0.73). Children with CRB were on vasopressor longer and transfused more red blood cells after the CRB than those without CRB. CONCLUSIONS: Our findings suggest that bleeding complicates critical illness in children.
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: Marianne E Nellis; Oliver Karam; Stacey L Valentine; Scot T Bateman; Kenneth E Remy; Jacques Lacroix; Jill M Cholette; Melania M Bembea; Robert T Russell; Marie E Steiner; Susan M Goobie; Marisa Tucci; Paul A Stricker; Simon J Stanworth; Meghan Delaney; Lani Lieberman; Jennifer A Muszynski; David F Bauer; Katherine Steffen; Daniel Nishijima; Juan Ibla; Sitaram Emani; Adam M Vogel; Thorsten Haas; Ruchika Goel; Gemma Crighton; Diana Delgado; Michelle Demetres; Robert I Parker Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.624
Authors: Marisa Tucci; Gemma Crighton; Susan M Goobie; Robert T Russell; Robert I Parker; Thorsten Haas; Marianne E Nellis; Adam M Vogel; Jacques Lacroix; Paul A Stricker Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.971
Authors: Lani Lieberman; Oliver Karam; Simon J Stanworth; Susan M Goobie; Gemma Crighton; Ruchika Goel; Jacques Lacroix; Marianne E Nellis; Robert I Parker; Katherine Steffen; Paul Stricker; Stacey L Valentine; Marie E Steiner Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.971
Authors: Oliver Karam; Robert T Russell; Paul Stricker; Adam M Vogel; Scot T Bateman; Stacey L Valentine; Philip C Spinella Journal: Pediatr Crit Care Med Date: 2018-09 Impact factor: 3.624
Authors: E Vincent S Faustino; Veronika Shabanova; Leslie J Raffini; Sarah B Kandil; Simon Li; Matthew G Pinto; Jill M Cholette; Sheila J Hanson; Marianne E Nellis; Cicero T Silva; Ranjit Chima; Anjali Sharathkumar; Kimberly A Thomas; Tara McPartland; Joana A Tala; Philip C Spinella Journal: Crit Care Med Date: 2021-03-01 Impact factor: 9.296