Leonora R Slatnick1, Dianne Thornhill2, Sara J Deakyne Davies3, James B Ford4, Halden F Scott5, Marilyn J Manco-Johnson6, Beth Boulden Warren7. 1. Department of Pediatrics, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, CO. 2. Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, CO. 3. Research Informatics, Children's Hospital Colorado, Aurora, CO. 4. University of Nebraska Medical Center, Omaha, NE. 5. Pediatric Emergency Medicine Department, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO. 6. Department of Pediatrics, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, CO; Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, CO. 7. Department of Pediatrics, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, CO; Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, CO. Electronic address: beth.warren@cuanschutz.edu.
Abstract
OBJECTIVE: To evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of emergency department ED encounters for children with suspected sepsis, in view of similar associations in adults. STUDY DESIGN: Laboratory and clinical data were extracted from a registry of emergency department encounters of children with suspected sepsis between April 1, 2012, and June 26, 2017. International Society of Thrombosis and Hemostasis DIC scores were calculated from laboratory values obtained within 24 hours of emergency department admission. Univariate logistic regression, multivariable logistic regression, and Cox regression were used to assess the influence of DIC scores on vasopressor use (primary outcome), mortality, ventilator requirement, pediatric intensive care unit admission, and hospital duration (secondary outcomes). The optimal DIC score cutoff for outcome prediction was determined. RESULTS: Of 1653 eligible patients, 284 had DIC scores within 24 hours, including 92 who required vasopressors and 23 who died within 1 year. An initial DIC score of ≥3 was the most sensitive and specific DIC score for predicting adverse outcomes. Those with a DIC score of ≥3 vs <3 had increased odds of vasopressor use in both univariate (OR, 4.48; 95% CI, 2.63-7.62; P < .001) and multivariable (OR, 3.78; 95% CI, 1.82-7.85; P < .001) analyses. Additionally, those with a DIC score of ≥3 vs <3 had increased 1-year mortality with a hazard ratio of 3.55 (95% CI, 1.46-8.64; P = .005). CONCLUSIONS: A DIC score of ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff of ≥5.
OBJECTIVE: To evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of emergency department ED encounters for children with suspected sepsis, in view of similar associations in adults. STUDY DESIGN: Laboratory and clinical data were extracted from a registry of emergency department encounters of children with suspected sepsis between April 1, 2012, and June 26, 2017. International Society of Thrombosis and Hemostasis DIC scores were calculated from laboratory values obtained within 24 hours of emergency department admission. Univariate logistic regression, multivariable logistic regression, and Cox regression were used to assess the influence of DIC scores on vasopressor use (primary outcome), mortality, ventilator requirement, pediatric intensive care unit admission, and hospital duration (secondary outcomes). The optimal DIC score cutoff for outcome prediction was determined. RESULTS: Of 1653 eligible patients, 284 had DIC scores within 24 hours, including 92 who required vasopressors and 23 who died within 1 year. An initial DIC score of ≥3 was the most sensitive and specific DIC score for predicting adverse outcomes. Those with a DIC score of ≥3 vs <3 had increased odds of vasopressor use in both univariate (OR, 4.48; 95% CI, 2.63-7.62; P < .001) and multivariable (OR, 3.78; 95% CI, 1.82-7.85; P < .001) analyses. Additionally, those with a DIC score of ≥3 vs <3 had increased 1-year mortality with a hazard ratio of 3.55 (95% CI, 1.46-8.64; P = .005). CONCLUSIONS: A DIC score of ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff of ≥5.
Authors: Michael Schwameis; Nina Buchtele; Andreas Schober; Christian Schoergenhofer; Peter Quehenberger; Bernd Jilma Journal: Eur J Emerg Med Date: 2017-10 Impact factor: 2.799
Authors: B L Warren; A Eid; P Singer; S S Pillay; P Carl; I Novak; P Chalupa; A Atherstone; I Pénzes; A Kübler; S Knaub; H O Keinecke; H Heinrichs; F Schindel; M Juers; R C Bone; S M Opal Journal: JAMA Date: 2001-10-17 Impact factor: 56.272