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Bleeding Scales Applicable to Critically Ill Children: A Systematic Review

Marianne E Nellis1, Julie Levasseur1, Judy Stribling2

  • 1Pediatric Critical Care Medicine, Department of Pediatrics, New York Presbyterian Hospital - Weill Cornell Medicine, New York, NY.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|March 30, 2019
PubMed

Insights

Validated bleeding scales are lacking for critically ill children. There is an urgent need for reliable tools to assess bleeding and outcomes in this vulnerable patient population.

Area of Science:

  • Pediatric Critical Care Medicine
  • Clinical Outcome Measurement
  • Hemorrhage Assessment Tools

Background:

  • Bleeding assessment is crucial in critically ill children.
  • Current bleeding scales may not be adequately validated for this population.
  • Reliable tools are needed to guide clinical decisions and research.

Purpose of the Study:

  • To summarize existing bleeding scales.
  • To evaluate their validation and applicability to critically ill children.
  • To identify gaps in current assessment tools.

Main Methods:

  • Conducted comprehensive electronic database searches (MEDLINE, EMBASE, Cochrane, Web of Science) from inception to 2017.
  • Included studies with bleeding scores, measurement tools, or hemorrhage assessments.
  • Reviewed 2,097 unique citations, with 20 full-text articles included.

Main Results:

  • Only 39% of reviewed scales were pediatric-specific; only 12% focused on critically ill patients.
  • Most scales (80%) considered the need for treatment (e.g., transfusions, surgery).
  • A majority (65%) lacked reported reliability or validation against clinical outcomes.

Conclusions:

  • A significant gap exists in validated bleeding scales for critically ill children.
  • Existing tools often lack pediatric-specific validation and rigorous outcome assessment.
  • There is an urgent need for the development and validation of reliable bleeding assessment tools for this population.
Abstract

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