Bleeding Scales Applicable to Critically Ill Children: A Systematic Review
Authors:
Nellis, M. E., Levasseur, J., Stribling, J., Faustino, E. V. S., Zantek, N. D., Sheth, S., and Karam, O.
Abstract:
OBJECTIVES: To summarize current bleeding scales and their validation to assess applicability to bleeding in critically ill children.
DATA SOURCES: We conducted electronic searches of Ovid MEDLINE, Ovid EMBASE, Cochrane Library, and Web of Science Core Collection databases from database inception to 2017.
STUDY SELECTION: Included studies contained a bleeding score, bleeding measurement tool, or clinical measurement of hemorrhage.
DATA EXTRACTION: We identified 2,097 unique citations; 20 full-text articles were included in the final review.
DATA SYNTHESIS: Of the 18 studies that included subjects (two others were expert consensus definitions), seven (39%) were pediatric-only, seven (39%) were adult-only, and four (22%) included both adults and children. Nine (50%) occurred with inpatients (two studies in critical care units), seven (39%) involved outpatients and two (11%) included both inpatients and outpatients. Thirty-nine percent of the scales were developed for those with idiopathic thrombocytopenic purpura and only two (12%) described critically ill patients. The majority (80%) included need for treatment (either RBC transfusion or surgical intervention). The majority (65%) did not report measures of reliability or validation to clinical outcomes.
CONCLUSIONS: There is a lack of validated bleeding scales to adequately assess bleeding and outcomes in critically ill children. Validated scales of bleeding are necessary and urgently needed.
Certain conditions originating in the perinatal period and related symptoms Codes for special purposes Diseases of and symptoms related to the blood and blood-forming organs and certain disorders involving the immune mechanism Diseases of and symptoms related to the circulatory system Neoplasms and related symptoms