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Assessing the Reliability of the Bleeding Assessment Scale in Critically Ill Children (BASIC) Definition: A
Marianne E Nellis1, Madhuradhar Chegondi2, Ariane Willems3,4
1Division of Pediatric Critical Care, Department of Pediatrics, Weill Cornell Medicine, New York, NY.
Insights
The Bleeding Assessment Scale in critically Ill Children (BASIC) definition reliably classifies bleeding severity in pediatric intensive care units. This tool ensures consistent evaluation for better clinical and research outcomes in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Clinical Research Methodology
Background:
- Bleeding is a common complication in critically ill children, impacting outcomes.
- Standardized definitions for bleeding severity are crucial for consistent clinical management and research.
- The Bleeding Assessment Scale in critically Ill Children (BASIC) was developed to classify bleeding severity.
Purpose of the Study:
- To evaluate the reliability of the BASIC definition in a diverse cohort of critically ill children.
- To assess inter-rater and intra-rater reliability of the BASIC definition.
- To explore associations between bleeding severity and clinical outcomes.
Main Methods:
- Prospective cohort study conducted in eight mixed pediatric intensive care units (PICUs) across three countries.
- Enrolled 328 children aged 0-18 years with noted bleeding.
- Bleeding events were classified as minimal, moderate, or severe by two independent physicians at two time points.
Main Results:
- Substantial overall inter-rater reliability (weighted kappa: 0.736) and almost-perfect intra-rater reliability (weighted kappa: 0.816) were observed.
- Platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen levels were associated with bleeding severity.
- More severe bleeding correlated with increased 28-day mortality, longer hospital stays, and more days on inotropic support.
Conclusions:
- The BASIC definition demonstrates high reliability for identifying and classifying bleeding severity in critically ill children.
- Consistent application of the BASIC definition in clinical practice and research is recommended.
- This standardized approach can lead to more reliable bleeding evaluations in pediatric critical care.
Objectives:
To determine the reliability of the Bleeding Assessment Scale in critically Ill Children (BASIC) definition of bleeding severity in a diverse cohort of critically ill children.
Design:
Prospective cohort study.
Setting:
Eight mixed PICUs in the Netherlands, Israel, and the United States.
Subjects:
Children ages 0-18 years admitted to participating PICUs from January 1, 2020, to December 31, 2022, with bleeding noted by bedside nurse.
Interventions:
None.
Measurements And Main Results:
The bleeding events were classified as minimal, moderate, or severe, according to the BASIC definition, by two independent physicians at two different time points. Patient demographic data, laboratory values, and clinical outcomes were collected. Three hundred twenty-eight patients were enrolled. The overall inter-rater reliability was substantial (weighted kappa coefficient, 0.736; 95% CI, 0.683-0.789), and the intra-rater reliability was "almost-perfect" (weighted kappa coefficient, 0.816; 95% CI, 0.769-0.863). The platelet count ( p = 0.008), prothrombin time ( p = 0.004), activated partial thromboplastin time ( p = 0.025), and fibrinogen levels ( p = 0.035) were associated with the bleeding severity, but the international normalized ratio was not ( p = 0.195). Patients were transfused blood components in response to any bleeding in 31% of cases and received hemostatic medications in 9% of cases. More severe bleeding was associated with increased 28-day mortality, longer hospital length of stay, and more days receiving inotropic support.
Conclusions:
The BASIC definition is a reliable tool for identifying and classifying bleeding in critically ill children. Implementing this definition into clinical and research practice may provide a consistent and reliable evaluation of bleeding.
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