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Life-Threatening Bleeding in Children: A Prospective Observational Study.
Julie C Leonard1, Cassandra D Josephson2, James F Luther3
1Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
Critical Care Medicine
|May 14, 2021
Summary
This study describes children with life-threatening bleeding, finding that mortality is high and death from hemorrhage occurs rapidly, especially in medically caused bleeding. Outcomes vary significantly by bleeding etiology in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Hemorrhagic shock management
- Transfusion medicine
Background:
- Life-threatening bleeding in children is a critical medical emergency requiring prompt recognition and management.
- Understanding the characteristics and outcomes associated with different etiologies of severe pediatric bleeding is essential for improving patient care.
- Previous studies have not comprehensively described the spectrum of life-threatening bleeding in a large pediatric cohort across multiple international centers.
Purpose of the Study:
- To characterize children experiencing life-threatening bleeding events.
- To compare patient demographics, clinical presentations, interventions, and outcomes based on the etiology of bleeding (trauma, operative, medical).
- To identify factors associated with mortality in this vulnerable pediatric population.
Main Methods:
- Prospective observational study conducted across 24 children's hospitals in the US, Canada, and Italy.
- Included children aged 0-17 years with life-threatening bleeding, defined by high transfusion volume or massive transfusion protocol activation.
- Collected data on patient characteristics, bleeding etiology, therapies administered, and clinical outcomes, including mortality.
Main Results:
- A total of 449 children were enrolled; 46.1% had trauma-related bleeding, 34.1% operative, and 19.8% medical.
- Children with medical bleeding had higher mortality (65.2%) and higher Pediatric Risk of Mortality scores compared to trauma and operative groups.
- High rates of acute respiratory distress syndrome (20.3%) and acute kidney injury (18.5%) were observed; 28-day mortality was 37.5%, with hemorrhage deaths occurring rapidly (86.5% within 24 hours).
Conclusions:
- Patient characteristics and outcomes in life-threatening pediatric bleeding are significantly influenced by the underlying cause.
- Mortality rates are high in children with life-threatening bleeding, particularly those with medical etiologies.
- Hemorrhage-related deaths in this population occur rapidly, underscoring the need for timely and aggressive interventions.
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