Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
Department of Pediatrics, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
J Crit Care. 2021 Jun;63:133-138. doi: 10.1016/j.jcrc.2020.09.028. Epub 2020 Sep 29.
We updated our findings on the epidemiology of clinically relevant bleeding (CRB) in critically ill children. We also determined the concordance of CRB as defined by the International Society of Thrombosis and Haemostasis, i.e., ISTH definition, and characteristics identified by pediatric intensivists in a recent survey, i.e., survey definition.
In a prospective cohort study, we included children <18 years old who were admitted to the pediatric intensive care unit for >1 day. We followed them daily for bleeding. Bayesian inference was used as the primary analytic tool to incorporate our prior findings.
Using the ISTH definition, the estimated frequency of CRB was 10.0% (95% credible interval, CrI: 7.6%, 12.8%) from 41 of 405 children who had CRB. The estimated frequency from 4 of 12 adolescents >13 years old who received mechanical ventilation or vasopressor support and had CRB was 32.9% (95% CrI: 12.0%, 58.8%). Using the survey definition, the estimated frequency of CRB for the entire cohort was 10.8% (95% CrI: 8.3%, 13.8%). Concordance between definitions for each bleeding event was 0.40 (95% confidence interval: 0.27, 0.52).
Our updated findings highlight the high frequency of CRB regardless of definition used for CRB.
我们更新了关于危重症儿童临床相关出血（CRB）的流行病学发现。我们还确定了国际血栓与止血学会（ISTH）定义的 CRB 与最近一项调查中儿科重症监护医师确定的特征（即调查定义）之间的一致性。
在一项前瞻性队列研究中，我们纳入了入住儿科重症监护病房>1 天的<18 岁儿童。我们每天对他们进行出血监测。贝叶斯推断被用作主要分析工具，以纳入我们之前的发现。
使用 ISTH 定义，405 例发生 CRB 的患儿中有 41 例（95%可信区间，CrI：7.6%，12.8%）估计有 CRB 发生。12 例>13 岁接受机械通气或血管加压支持且发生 CRB 的青少年中，有 4 例估计的 CRB 发生率为 32.9%（95% CrI：12.0%，58.8%）。使用调查定义，整个队列的 CRB 发生率估计为 10.8%（95% CrI：8.3%，13.8%）。两种定义下每个出血事件的一致性为 0.40（95%置信区间：0.27，0.52）。
我们的更新发现强调了无论使用何种 CRB 定义，CRB 的发生率都很高。
