Bleeding Scales Applicable to Critically Ill Children: A Systematic Review

Marianne E. Nellis, Julie Levasseur, Judy Stribling, E. Vincent S. Faustino, Nicole D. Zantek, Sujit Sheth, Oliver Karam

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)603-607
Number of pages5
JournalPediatric Critical Care Medicine
Issue number7
StatePublished - Jul 1 2019

Bibliographical note

Funding Information:
Dr. Zantek received research funding from Octapharma, Bayer HealthCare, Terumo BCT, and she disclosed that she is an executive board member of North American Specialized Coagulation Laboratory, and her husband is an employee of Boston Scientific and has a financial interest in ENDO International PLC. Dr. Sheth received funding from Celgene (related to Luspater-cept), Novartis (related to deferasirox), Apopharma (related to deferiprone), and Bluebird Bio (related to lentiglobin therapies). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies


  • critical care
  • critical illness
  • hemorrhage
  • intensive care units
  • pediatrics
  • severity of illness

PubMed: MeSH publication types

  • Journal Article
  • Systematic Review

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