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Bleeding Assessment Scale in Critically Ill Children (BASIC): Physician-Driven Diagnostic Criteria for Bleeding
Marianne E Nellis1, Marisa Tucci2, Jacques Lacroix2
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY.
Insights
Researchers developed the Bleeding Assessment Scale in Critically Ill Children (BASIC) to define bleeding severity in pediatric intensive care units. This new scale offers clear criteria for assessing bleeding in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Clinical Definitions
Background:
- Bleeding is common in critically ill children, but lacks a standardized severity definition.
- Accurate assessment of bleeding severity is crucial for clinical management and research in pediatric intensive care.
Purpose of the Study:
- To develop and validate diagnostic criteria for assessing bleeding severity in critically ill children.
- Establish a physician-driven definition for clinically relevant bleeding in this population.
Main Methods:
- A Delphi consensus process involving 24 international multidisciplinary experts in bleeding and hemostasis.
- Development of a provisional definition from 35 bleeding descriptors, refined through seven rounds of voting.
- Prospective cohort study to test the internal validity and inter-rater reliability of the developed criteria.
Main Results:
- The Bleeding Assessment Scale in Critically Ill Children (BASIC) categorizes bleeding into severe, moderate, and minimal based on organ dysfunction, vital signs, anemia, and quantifiable bleeding.
- The definition demonstrated substantial inter-rater reliability (kappa = 0.74) when applied to 40 children with 46 bleeding episodes.
- Criteria exclude treatments like red cell transfusions or surgical interventions.
Conclusions:
- The BASIC is the first physician-driven definition for bleeding severity in critically ill children, established through international expert consensus.
- This definition provides clear criteria, aiming to improve clinical communication among pediatric intensivists.
- The BASIC is expected to aid in designing future epidemiologic studies and clinical trials in pediatric critical care if further validated with patient outcomes.
Objective:
Although bleeding frequently occurs in critical illness, no published definition to date describes the severity of bleeding accurately in critically ill children. We sought to develop diagnostic criteria for bleeding severity in critically ill children.
Design:
Delphi consensus process of multidisciplinary experts in bleeding/hemostasis in critically ill children, followed by prospective cohort study to test internal validity.
Setting:
PICU.
Patients:
Children at risk of bleeding in PICUs.
Interventions:
None.
Measurements And Main Results:
Twenty-four physicians worldwide (10 on a steering committee and 14 on an expert committee) from disciplines related to bleeding participated in development of a definition for clinically relevant bleeding. A provisional definition was created from 35 descriptors of bleeding. Using a modified online Delphi process and conference calls, the final definition resulted after seven rounds of voting. The Bleeding Assessment Scale in Critically Ill Children definition categorizes bleeding into severe, moderate, and minimal, using organ dysfunction, proportional changes in vital signs, anemia, and quantifiable bleeding. The criteria do not include treatments such as red cell transfusion or surgical interventions performed in response to the bleed. The definition was prospectively applied to 40 critically ill children with 46 distinct bleeding episodes. The kappa statistic between the two observers was 0.74 (95% CI, 0.57-0.91) representing substantial inter-rater reliability.
Conclusions:
The Bleeding Assessment Scale in Critically Ill Children definition of clinically relevant bleeding severity is the first physician-driven definition applicable for bleeding in critically ill children derived via international expert consensus. The Bleeding Assessment Scale in Critically Ill Children definition includes clear criteria for bleeding severity in critically ill children. We anticipate that it will facilitate clinical communication among pediatric intensivists pertaining to bleeding and serve in the design of future epidemiologic studies if it is validated with patient outcomes.
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