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Bayesian analysis of the epidemiology of bleeding in critically ill children
Tyler Greenway1, Lindsay Eysenbach1, Veronika Shabanova2
1Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
Insights
Clinically relevant bleeding (CRB) is frequent in critically ill children, affecting approximately 10% of patients. This study compared two definitions of CRB, finding similar frequencies but low concordance between them.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Epidemiology
Background:
- Clinically relevant bleeding (CRB) is a significant concern in critically ill children.
- Understanding the epidemiology and accurate definition of CRB is crucial for patient management and outcomes.
Purpose of the Study:
- To update findings on the epidemiology of CRB in critically ill children.
- To determine the concordance between the International Society of Thrombosis and Haemostasis (ISTH) definition and a survey-based definition used by pediatric intensivists.
Main Methods:
- Prospective cohort study including children under 18 admitted to a pediatric intensive care unit for more than one day.
- Daily monitoring for bleeding events.
- Bayesian inference used for analysis, incorporating prior findings.
Main Results:
- The estimated frequency of CRB was 10.0% (95% CrI: 7.6%, 12.8%) using the ISTH definition.
- For adolescents over 13 receiving mechanical ventilation or vasopressors, CRB frequency was 32.9% (95% CrI: 12.0%, 58.8%).
- Using the survey definition, the estimated CRB frequency was 10.8% (95% CrI: 8.3%, 13.8%). Concordance between definitions was 0.40 (95% CI: 0.27, 0.52).
Conclusions:
- Updated findings confirm a high frequency of CRB in critically ill children, irrespective of the definition employed.
- The study highlights potential discrepancies in CRB identification between established criteria and clinical practice, underscoring the need for standardized definitions.
Purpose:
We updated our findings on the epidemiology of clinically relevant bleeding (CRB) in critically ill children. We also determined the concordance of CRB as defined by the International Society of Thrombosis and Haemostasis, i.e., ISTH definition, and characteristics identified by pediatric intensivists in a recent survey, i.e., survey definition.
Methods:
In a prospective cohort study, we included children <18 years old who were admitted to the pediatric intensive care unit for >1 day. We followed them daily for bleeding. Bayesian inference was used as the primary analytic tool to incorporate our prior findings.
Results:
Using the ISTH definition, the estimated frequency of CRB was 10.0% (95% credible interval, CrI: 7.6%, 12.8%) from 41 of 405 children who had CRB. The estimated frequency from 4 of 12 adolescents >13 years old who received mechanical ventilation or vasopressor support and had CRB was 32.9% (95% CrI: 12.0%, 58.8%). Using the survey definition, the estimated frequency of CRB for the entire cohort was 10.8% (95% CrI: 8.3%, 13.8%). Concordance between definitions for each bleeding event was 0.40 (95% confidence interval: 0.27, 0.52).
Conclusions:
Our updated findings highlight the high frequency of CRB regardless of definition used for CRB.
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