E Vincent S Faustino1, Oliver Karam2, Robert I Parker3, Sheila J Hanson4, Leonardo R Brandão5,6, Paul Monagle7,8,9,10. 1. Section of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut. 2. Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia. 3. Hematology/Oncology, Department of Pediatrics (Emeritus), Renaissance School of Medicine, Stony Brook University, Stony Brook, New York. 4. Critical Care Section, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin. 5. Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada. 6. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 7. Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia. 8. Department of Clinical Haematology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia. 9. Murdoch Children's Research Institute, Parkville, Victoria, Australia. 10. Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
Abstract
CONTEXT: Previous criteria for coagulation dysfunction in critically ill children were based mainly on expert opinion. OBJECTIVE: To evaluate current evidence regarding coagulation tests associated with adverse outcomes in children to inform criteria for coagulation dysfunction during critical illness. DATA SOURCES: Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020 by using a combination of medical subject heading terms and text words to define concepts of coagulation dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION: Studies were included if critically ill children with coagulation dysfunction were evaluated, if performance characteristics of assessment and/or scoring tools to screen for coagulation dysfunction were evaluated, and if outcomes related to mortality or functional status, organ-specific outcomes, or other patient-centered outcomes were assessed. DATA EXTRACTION: Data were abstracted from each eligible study into a standard data extraction form, along with risk of bias assessment, by a task force member. RESULTS: The systematic review supports the presence of at least 2 of the following criteria reflecting coagulation dysfunction in the absence of liver dysfunction: platelet count <100 000 cells per μL, international normalized ratio >1.5, fibrinogen level <150 mg/dL, and D-dimer value above 10 times the upper limit of normal, or above the assay's upper limit of detection if this limit is below 10 times the upper limit of normal. LIMITATIONS: The proposed criteria for coagulation dysfunction are limited by the available evidence and will require future validation. CONCLUSIONS: Validation of the proposed criteria and identified scientific priorities will enhance our understanding of coagulation dysfunction in critically ill children.
CONTEXT: Previous criteria for coagulation dysfunction in critically ill children were based mainly on expert opinion. OBJECTIVE: To evaluate current evidence regarding coagulation tests associated with adverse outcomes in children to inform criteria for coagulation dysfunction during critical illness. DATA SOURCES: Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020 by using a combination of medical subject heading terms and text words to define concepts of coagulation dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION: Studies were included if critically ill children with coagulation dysfunction were evaluated, if performance characteristics of assessment and/or scoring tools to screen for coagulation dysfunction were evaluated, and if outcomes related to mortality or functional status, organ-specific outcomes, or other patient-centered outcomes were assessed. DATA EXTRACTION: Data were abstracted from each eligible study into a standard data extraction form, along with risk of bias assessment, by a task force member. RESULTS: The systematic review supports the presence of at least 2 of the following criteria reflecting coagulation dysfunction in the absence of liver dysfunction: platelet count <100 000 cells per μL, international normalized ratio >1.5, fibrinogen level <150 mg/dL, and D-dimer value above 10 times the upper limit of normal, or above the assay's upper limit of detection if this limit is below 10 times the upper limit of normal. LIMITATIONS: The proposed criteria for coagulation dysfunction are limited by the available evidence and will require future validation. CONCLUSIONS: Validation of the proposed criteria and identified scientific priorities will enhance our understanding of coagulation dysfunction in critically ill children.