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The impact of clinically significant upper gastrointestinal bleeding acquired in a pediatric intensive care unit

F Gauvin1, M A Dugas, M Chaïbou

  • 1Pediatric Intensive Care Unit, Department of Pediatrics, Sainte-Justine Hospital, Montreal, Canada.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 10, 2003
PubMed

Insights

Clinically significant upper gastrointestinal bleeding (UGIB) in pediatric intensive care units (PICU) leads to worse outcomes and higher costs. Non-significant UGIB, however, showed no discernible impact on patients.

Area of Science:

  • Pediatric critical care medicine
  • Gastroenterology
  • Health economics

Background:

  • Upper gastrointestinal bleeding (UGIB) is a potential complication in pediatric intensive care units (PICUs).
  • Understanding the clinical and economic consequences of UGIB in this vulnerable population is crucial for resource allocation and patient management.

Purpose of the Study:

  • To quantify the clinical and economic burden of upper gastrointestinal bleeding (UGIB) acquired within a pediatric intensive care unit (PICU).

Main Methods:

  • A prospective case-control-within-cohort study was conducted in a university hospital PICU.
  • Patients were categorized into clinically significant UGIB (CS-UGIB), non-clinically significant UGIB (NS-UGIB), and no UGIB (Ø-UGIB) groups.
  • Pairing was based on survival, Pediatric Risk of Mortality Score, respiratory failure, coagulopathy, and age; costs included stay, medical staff, ventilation, and transfusions.

Main Results:

  • The CS-UGIB group experienced significantly higher rates of red blood cell transfusions, longer ventilation durations, extended PICU stays, and lower hemoglobin levels compared to control groups.
  • Cost analysis revealed a substantial economic impact for CS-UGIB (Can$20,062.67/patient/stay) versus NS-UGIB (Can$6104.77) and Ø-UGIB (Can$5457.25).
  • No significant clinical or economic differences were observed between the NS-UGIB and Ø-UGIB groups.

Conclusions:

  • Clinically significant UGIB in the PICU setting imposes a considerable clinical and economic burden.
  • Non-clinically significant UGIB does not appear to impact patient outcomes or healthcare costs.
  • Further research into the benefits of UGIB prophylaxis for high-risk pediatric patients in the PICU is warranted.
Abstract

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