Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
Crit Care Med. 2021 Nov 1;49(11):1943-1954. doi: 10.1097/CCM.0000000000005075.
The purpose of our study was to describe children with life-threatening bleeding.
We conducted a prospective observational study of children with life-threatening bleeding events.
Twenty-four childrens hospitals in the United States, Canada, and Italy participated.
Children 0-17 years old who received greater than 40 mL/kg total blood products over 6 hours or were transfused under massive transfusion protocol were included.
Children were compared according bleeding etiology: trauma, operative, or medical.
Patient characteristics, therapies administered, and clinical outcomes were analyzed. Among 449 enrolled children, 55.0% were male, and the median age was 7.3 years. Bleeding etiology was 46.1% trauma, 34.1% operative, and 19.8% medical. Prior to the life-threatening bleeding event, most had age-adjusted hypotension (61.2%), and 25% were hypothermic. Children with medical bleeding had higher median Pediatric Risk of Mortality scores (18) compared with children with trauma (11) and operative bleeding (12). Median Glasgow Coma Scale scores were lower for children with trauma (3) compared with operative (14) or medical bleeding (10.5). Median time from bleeding onset to first transfusion was 8 minutes for RBCs, 34 minutes for plasma, and 42 minutes for platelets. Postevent acute respiratory distress syndrome (20.3%) and acute kidney injury (18.5%) were common. Twenty-eight-day mortality was 37.5% and higher among children with medical bleeding (65.2%) compared with trauma (36.1%) and operative (23.8%). There were 82 hemorrhage deaths; 65.8% occurred by 6 hours and 86.5% by 24 hours.
Patient characteristics and outcomes among children with life-threatening bleeding varied by cause of bleeding. Mortality was high, and death from hemorrhage in this population occurred rapidly.
本研究旨在描述危及生命的出血患儿的临床特征。
我们开展了一项针对危及生命出血事件患儿的前瞻性观察性研究。
美国、加拿大和意大利的 24 家儿童医院参与了此项研究。
纳入标准为年龄在 0-17 岁之间、6 小时内输注超过 40ml/kg 全血制品或根据大出血方案输血的患儿。
根据出血病因（创伤、手术或内科）对患儿进行比较。
分析了患儿的一般特征、治疗措施和临床结局。在纳入的 449 名患儿中，55.0%为男性，中位年龄为 7.3 岁。出血病因中，创伤占 46.1%，手术占 34.1%，内科占 19.8%。在发生危及生命的出血事件之前，大多数患儿都存在校正年龄后的低血压（61.2%），25%患儿体温过低。与创伤性出血（11 分）和手术性出血（12 分）患儿相比，内科性出血患儿的儿科危重病评分（18 分）更高。创伤性出血患儿的格拉斯哥昏迷评分（3 分）低于手术性出血（14 分）和内科性出血（10.5 分）患儿。从出血开始到首次输血的中位时间为红细胞输注 8 分钟，血浆输注 34 分钟，血小板输注 42 分钟。事件后急性呼吸窘迫综合征（20.3%）和急性肾损伤（18.5%）较为常见。28 天死亡率为 37.5%，内科性出血患儿（65.2%）的死亡率高于创伤性出血（36.1%）和手术性出血（23.8%）患儿。共有 82 例患儿因出血死亡，其中 65.8%发生在 6 小时内，86.5%发生在 24 小时内。
不同病因所致危及生命的出血患儿的一般特征和结局存在差异。死亡率较高，该人群的出血性死亡发生迅速。
