Bleeding Assessment Scale in Critically Ill Children (BASIC): Physician-Driven Diagnostic Criteria for Bleeding...

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.