Disseminated Intravascular Coagulation in a High-Risk Pediatric Oncology Patient: A Pediatric Simulation Case for...

Disseminated intravascular coagulation (DIC) is an acquired life-threatening condition defined by systemic coagulation imbalance. Due to the high mortality associated with this condition, it is paramount that providers quickly recognize key clinical signs and laboratory value changes.

This simulation was designed for pediatric residents, fellows, or other providers who treat patients at risk for DIC. The case was a 6-year-old boy with newly diagnosed leukemia admitted to the oncology service for induction chemotherapy who presents with a nosebleed, then develops profuse, multisite bleeding consistent with a diagnosis of DIC. The goals for the team were to treat the epistaxis, verbalize DIC as the diagnosis, and address hemodynamic instability due to DIC. Directly following completion of the scenario, a debriefing session was facilitated using the PEARLS (Promoting Excellence and Reflective Learning) method. A pre- and postsimulation survey was completed that consisted of participant self-assessment of their ability to achieve each of the three educational objectives, where they rated their confidence in managing epistaxis, recognizing DIC, and achieving hemodynamic stability on a 3-point scale (1 = almost there, 2 = proficient, 3 = mastery).

Of the 91 simulation participants, which included pediatric and pharmacy residents, 89 completed the survey. The median competency score significantly increased by 0.49 points (99% CI, 0.37 to 0.61) from pre- to postsimulation (p < .001).

This simulation serves as a learning tool for teaching the clinical and laboratory presentation of DIC, guiding management of epistaxis, and addressing hemodynamic instability.