Journal article
Assessing the Reliability of the Bleeding Assessment Scale in Critically Ill Children (BASIC) Definition: A Prospective Cohort Study
Pediatric critical care medicine, Vol.26(1), pp.e3-e11
01/2025
DOI: 10.1097/PCC.0000000000003638
PMCID: PMC11774477
PMID: 39560732
Abstract
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.
Details
- Title: Subtitle
- Assessing the Reliability of the Bleeding Assessment Scale in Critically Ill Children (BASIC) Definition: A Prospective Cohort Study
- Creators
- Marianne E. Nellis - Cornell UniversityMadhuradhar Chegondi - University of IowaAriane Willems - Queen Fabiola Children's University HospitalMashael Alqatani - Nemours Children's ClinicAli McMichael - University of ArizonaAdi A. Aran - Hadassah Medical CenterReut Kassif Lerner - Edmond and Lily Safra Children's HospitalOliver Karam - Yale UniversityBleeding Assessment Scale in critically Ill Children (BASIC)-Kappa InvestigatorsPediatric Critical Care Blood Research Network (BloodNet)Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
- Resource Type
- Journal article
- Publication Details
- Pediatric critical care medicine, Vol.26(1), pp.e3-e11
- DOI
- 10.1097/PCC.0000000000003638
- PMID
- 39560732
- PMCID
- PMC11774477
- NLM abbreviation
- Pediatr Crit Care Med
- ISSN
- 1529-7535
- eISSN
- 1947-3893
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Grant note
- National Center for Advancing Translational Sciences of the National Institutes of Health: UL1TR002384
Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR002384.
- Language
- English
- Electronic publication date
- 11/19/2024
- Date published
- 01/2025
- Academic Unit
- Stead Family Department of Pediatrics
- Record Identifier
- 9984749256002771
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