Coagulation Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Area of Science:

• Pediatric critical care medicine
• Hematology
• Coagulation disorders

Background:

• Existing criteria for coagulation dysfunction in critically ill children lack robust evidence, relying primarily on expert opinion.
• There is a need for evidence-based criteria to accurately identify and manage coagulation dysfunction in pediatric critical illness.

Purpose of the Study:

• To systematically review current evidence linking coagulation tests to adverse outcomes in critically ill children.
• To inform the development of evidence-based criteria for coagulation dysfunction in this population.

Main Methods:

• Conducted comprehensive electronic searches of PubMed and Embase (1992-2020).
• Included studies evaluating critically ill children with coagulation dysfunction, assessing screening tools, and measuring patient-centered outcomes.
• Extracted data and assessed risk of bias for eligible studies.

Main Results:

• Proposed criteria for coagulation dysfunction (in absence of liver dysfunction) include at least two of: platelet count <100,000/μL, international normalized ratio (INR) >1.5, fibrinogen <150 mg/dL, or D-dimer >10x upper limit of normal.
• These criteria are supported by a systematic review of available evidence.

Conclusions:

• The proposed criteria offer a foundation for diagnosing coagulation dysfunction in critically ill children.
• Future validation of these criteria is essential to enhance understanding and management of coagulation disorders in this vulnerable group.