Bleeding during critical illness: a prospective cohort study using a new measurement tool

Area of Science:

• Critical care medicine
• Clinical research methodology
• Hemostasis and thrombosis

Background:

• Bleeding is a common complication in critically ill patients.
• Accurate assessment of bleeding is crucial for patient management and clinical trial design.
• Existing tools for measuring bleeding in intensive care unit (ICU) patients may be insufficient.

Purpose of the Study:

• To determine the incidence, severity, duration, and consequences of bleeding in critically ill patients.
• To evaluate the performance characteristics of a novel bleeding assessment tool, HEmorrhage MEasurement (HEME).

Main Methods:

• Prospective study of 100 consecutive medical-surgical ICU patients.
• Daily, duplicate, and independent bleeding assessments using the HEME tool by blinded assessors.
• Inter-rater agreement and construct validity assessed using phi; risk factors for major bleeding identified via multivariable Cox proportional hazards model.

Main Results:

• 90% of patients experienced bleeding; 94.8% were minor, 5.2% were major.
• The HEME tool demonstrated excellent inter-rater reliability (phi = 0.98).
• Independent risk factors for major bleeding included decreased platelet count and prolonged partial thromboplastin time; renal failure and prophylactic anticoagulation were not significant predictors.
• Major bleeding was associated with increased blood transfusions and longer ICU stays.

Conclusions:

• Bleeding is highly prevalent in ICU patients, predominantly minor.
• Major bleeding occurred in 20% of patients, linked to coagulation abnormalities but not prophylactic anticoagulants.
• Established bleeding rates can guide future clinical trials, and the HEME tool is effective for measuring bleeding in critical care settings.