Marianne Nellis, MD, MS
Pediatric Intensivist
New York-Presbyterian Hospital/Weill Cornell Medical College
New York, NY
Disclosure information not submitted.
Ariane Willems, MD
Senior specialist
Leiden University, Netherlands
Disclosure information not submitted.
Mashael Alqahtani, MD, MS
Assistant Professor
Nemours Childrens Hospital, United States
Disclosure information not submitted.
Ewa Gerlak
Clinical Research Coordinator
Weill Cornell Medicine, Cornell University
NEW YORK, United States
Disclosure information not submitted.
Oliver Karam, PhD, MD,
Professor, Division Chief
Virginia Commonwealth University Medical Center, United States
Disclosure information not submitted.
Title: Prospective Validation of BASIC Definition of Bleeding in Diverse Cohort of Critically Ill Children
Introduction : Bleeding is a common complication of critical illness and independently associated with increased mortality. However, the exact incidence of bleeding in the pediatric intensive care unit (PICU) is unclear because of the lack of relevant definitions of bleeding. The Bleeding Assessment Scale in critically Ill Children (BASIC) definition was recently developed. We sought to validate the BASIC definition, in terms of inter- and intra-rater reliability, in a diverse cohort of critically ill children.
Methods: We prospectively enrolled bleeding children ages 0 to 18 years in four PICUs. The degree of bleeding at time of enrollment for each child was assessed using the BASIC definition by two independent observers at two time points. An interrater and intra-rater reliability analysis using the Kappa statistic was performed to determine consistency among raters. In addition, demographic and clinical information was collected.
Results: One-hundred and fifty-nine bleeding children were enrolled. Fifty-seven percent (91/159) were male with a median (IQR) age of 12 (2.7-15.2) years. Thirty-seven percent (58/159) were assessed to have severe bleeding, 28% (45/159) moderate bleeding, and 35% (56/159) had minimal bleeding. From 300 paired assessments of bleeding at enrollment by two observers using the BASIC definition, the kappa for inter-rater reliability was 0.675 (p< 0.001), 95% CI (0.606, 0.744). From 304 paired assessments of bleeding at enrollment at two points in time, the kappa for intra-rater reliability was 0.761 (p< 0.001), 95% CI (0.701, 0.821).
Conclusions: In a diverse cohort of critically ill children with varying degrees of bleeding, the BASIC definition demonstrated substantial agreement.