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An evidence-based threshold for thrombocytopenia associated with clinically significant bleeding in pediatric

Paul C Moorehead1, Janelle Cyr, Robert Klaassen

  • 1From the Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada. pmoorehead@yahoo.com

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|July 5, 2012
PubMed

Insights

Clinically significant bleeding affects nearly 9% of pediatric intensive care unit patients. Low platelet counts, mechanical ventilation, and cardiac surgery are key risk factors for this complication.

Area of Science:

  • Pediatric critical care medicine
  • Hematology
  • Epidemiology

Background:

  • Clinically significant bleeding (CSB) is a serious complication in pediatric intensive care units (PICUs).
  • Previous reports may underestimate the incidence and risk factors of CSB in critically ill children.

Purpose of the Study:

  • To investigate the epidemiology of CSB in a PICU setting.
  • To identify specific risk factors associated with CSB in pediatric patients.

Main Methods:

  • Retrospective cohort study conducted over six months.
  • Included 214 consecutive patients admitted to a tertiary care children's hospital PICU.
  • Utilized a composite outcome definition for CSB and recursive partitioning for risk factor analysis.

Main Results:

  • CSB occurred in 8.9% of eligible PICU patients.
  • A platelet count below 100 × 10/L was identified as a significant risk factor.
  • Mechanical ventilation, antibiotic/antacid use, multiple procedures, and cardiac surgery also increased CSB risk.

Conclusions:

  • CSB is a more frequent complication in PICU patients than previously recognized.
  • An evidence-based threshold for thrombocytopenia as a risk factor warrants further investigation in prospective studies.
Abstract

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