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Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit
J Lacroix1, D Nadeau, S Laberge
1Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, PQ, Canada.
Insights
Upper gastrointestinal (GI) bleeding occurs in 6.4% of pediatric ICU patients. Clinically significant GI bleeding is rare, even without prophylaxis, highlighting the need for targeted interventions.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Epidemiology
Background:
- Upper gastrointestinal (GI) bleeding is a potential complication in critically ill children.
- Understanding the incidence and risk factors is crucial for effective management in pediatric intensive care units (ICUs).
Purpose of the Study:
- To determine the frequency of upper GI bleeding in pediatric ICUs.
- To identify independent risk factors and confounding variables associated with upper GI bleeding in this population.
Main Methods:
- Prospective, descriptive study conducted over 55 weeks in a university hospital's pediatric ICU.
- Data collected on 984 children, defining upper GI bleeding by hematemesis or nasogastric tube drainage.
- Multivariate analysis used to identify risk factors.
Main Results:
- An overall incidence of 6.4% for upper GI bleeding was observed among 984 pediatric ICU patients.
- Independent risk factors identified include high Pediatric Risk of Mortality score, coagulopathy, pneumonia, and multitrauma.
- Clinically important upper GI bleeding occurred in only four patients, often associated with coagulopathy.
Conclusions:
- The frequency of upper GI bleeding in pediatric ICUs is substantial.
- However, the rate of clinically important upper GI bleeding is low, even without routine prophylaxis.
Objective:
To determine the frequency of upper gastrointestinal (GI) bleeding in pediatric ICUs.
Design:
Prospective, descriptive study.
Setting:
Pediatric ICU in a university hospital.
Patients:
All children admitted to a pediatric ICU over a 55-wk period.
Intervention:
None.
Measurements And Main Results:
Upper GI bleeding was considered to be present if there was an episode of hematemesis or if any amount of blood was seen in drainage from a nasogastric tube. Sixty-three (6.4%) upper GI bleeds were detected among 984 patients: 5.2% in 698 patients who did not receive upper GI bleeding prophylaxis, and 9.4% in 286 patients who did receive some prophylaxis. Density was defined as the number of events/1000 days.patient. The mean density was 10.8 GI bleeding episodes/1000 days.patient in a pediatric ICU. A multivariate analysis detected four independent risk factors or risk markers for upper GI bleeding: high Pediatric Risk of Mortality score, coagulopathy, pneumonia, and multitrauma. Age, sex, hepatic and respiratory failures were identified as confounding variables. An upper GI bleeding episode was defined as being clinically important if hypotension, death, or transfusion occurred within 24 hrs after the bleeding. There were four clinically important GI bleeding episodes. All were caused, at least in part, by a coagulopathy. The GI bleeding was associated with a need for transfusion in four children, and with hypotension in two.
Conclusions:
The frequency of upper GI bleeding is substantial, but the rate of occurrence of clinically important upper GI bleeding is low, even in a pediatric ICU where most patients do not receive any prophylaxis.