Bayesian analysis of the epidemiology of bleeding in critically ill children

Purpose: We updated our findings on the epidemiology of clinically relevant bleeding (CRB) in critically ill children. We also determined the concordance of CRB as defined by the International Society of Thrombosis and Haemostasis, i.e., ISTH definition, and characteristics identified by pediatric intensivists in a recent survey, i.e., survey definition. Methods: In a prospective cohort study, we included children <18 years old who were admitted to the pediatric intensive care unit for >1 day. We followed them daily for bleeding. Bayesian inference was used as the primary analytic tool to incorporate our prior findings. Results: Using the ISTH definition, the estimated frequency of CRB was 10.0% (95% credible interval, CrI: 7.6%, 12.8%) from 41 of 405 children who had CRB. The estimated frequency from 4 of 12 adolescents >13 years old who received mechanical ventilation or vasopressor support and had CRB was 32.9% (95% CrI: 12.0%, 58.8%). Using the survey definition, the estimated frequency of CRB for the entire cohort was 10.8% (95% CrI: 8.3%, 13.8%). Concordance between definitions for each bleeding event was 0.40 (95% confidence interval: 0.27, 0.52). Conclusions: Our updated findings highlight the high frequency of CRB regardless of definition used for CRB. (c) 2020 Elsevier Inc. All rights reserved.