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Evaluation of Disseminated Intravascular Coagulation Scores in Critically Ill Pediatric Patients
Won Kyoung Jhang1, Eun Ju Ha, Seong Jong Park
1All authors: Division of Pediatric Critical Care medicine, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Insights
The Japanese Association for Acute Medicine (JAAM) criteria detected disseminated intravascular coagulation (DIC) more often than the International Society on Thrombosis and Hemostasis (ISTH) criteria in critically ill children. Both scoring systems effectively predict mortality in pediatric intensive care units.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Thrombohemorrhagic Disorders
Background:
- Disseminated intravascular coagulation (DIC) is a critical condition associated with organ failure.
- Accurate and early detection of DIC is vital for managing critically ill pediatric patients.
- Existing scoring systems, such as those from the International Society on Thrombosis and Hemostasis (ISTH) and the Japanese Association for Acute Medicine (JAAM), aim to standardize DIC diagnosis.
Purpose of the Study:
- To compare the detection rates of DIC using ISTH and JAAM criteria in critically ill pediatric patients upon ICU admission.
- To evaluate the prognostic value of these DIC scoring systems in predicting outcomes for pediatric ICU patients.
- To assess the correlation between DIC scores and other established pediatric severity scores.
Main Methods:
- A single-center retrospective observational study.
- Inclusion of 191 pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) between January 2013 and December 2014.
- Comparison of DIC diagnosis using ISTH and JAAM criteria, and correlation with Pediatric Risk of Mortality III (PRISM III), modified Sequential Organ Failure Assessment (SOFA), and Pediatric Multiple Organ Dysfunction Syndrome (PODS) scores.
Main Results:
- DIC was diagnosed in 15.7% of patients by ISTH criteria and 29.8% by JAAM criteria, with a diagnostic concordance of 52.6%.
- Higher scores in PRISM III, modified SOFA, and PODS correlated with increased DIC prevalence.
- DIC scores demonstrated a strong correlation with these severity scores and were significantly associated with 28-day mortality (9.9% overall).
Conclusions:
- Both ISTH and JAAM scoring systems are valuable for detecting DIC in critically ill pediatric patients.
- DIC scores correlate well with established pediatric severity scores, reinforcing their utility.
- DIC scoring systems show significant association with 28-day mortality, indicating their potential as prognostic indicators in pediatric critical care.
Objectives:
Disseminated intravascular coagulation is a complex systemic thrombohemorrahgic disorder, which may contribute to organ failure. We aimed to compare the detection rate of the disseminated intravascular coagulation, early in the course of ICU admission, of the two disseminated intravascular coagulation scoring systems defined by International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine criteria and the prognostic value of disseminated intravascular coagulation scores in critically ill pediatric patients.
Design:
Single-center retrospective observational study.
Setting:
PICU in a tertiary care children's hospital.
Patients:
Pediatric patients admitted in the PICU between January 2013 and December 2014.
Interventions:
None.
Measurements And Main Results:
A total of 191 patients were included. Among them, 15.7% and 29.8% of the patients were diagnosed with disseminated intravascular coagulation by International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine criteria, respectively. The diagnostic concordance rate between the International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine scoring systems was 52.6%. As the Pediatric Risk of Mortality III, the modified Sequential Organ Failure Assessment, and the Pediatric Multiple Organ Dysfunction Syndrome scores increased, the percentage of patients with disseminated intravascular coagulation increased stepwise. The disseminated intravascular coagulation scores correlated well with these severity scores. Overall, the 28-day mortality was 9.9%. There were significant differences in most variables consisting of the International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine scoring systems between survivor and nonsurvivors. Patients detected to have disseminated intravascular coagulation by the International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine scoring systems showed higher mortality than patients without disseminated intravascular coagulation. The areas under the receiver operating characteristic curve of the Japanese Association for Acute Medicine score and International Society on Thrombosis and Hemostasis score were 0.788 (95% CI, 0.675-0.900) and 0.716 (95% CI, 0.598-0.834), respectively.
Conclusions:
Both the International Society on Thrombosis and Hemostasis and the Japanese Association for Acute Medicine scoring systems are useful for detection of the disseminated intravascular coagulation in critically ill pediatric patients. These scores correlate well with other severity scores, including Pediatric Risk of Mortality III, modified Sequential Organ Failure Assessment, and Pediatric Multiple Organ Dysfunction Syndrome. Disseminated intravascular coagulation scores are also significantly associated with 28-day mortality, suggesting that these could be promising prognostic factors.
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