Clinical and laboratory variables associated with clinically significant bleeding in pediatric intensive care unit patients

Existing research into clinically significant bleeding in Pediatric Intensive Care Unit (PICU) patients is limited to specific bleeding sites and specific patient groups. Existing literature does not accurately describe the epidemiology of clinically significant bleeding in the PICU and may not correctly identify potential risk markers. Using a broadly inclusive definition of clinically significant bleeding, we conducted a retrospective cohort study of PICU patients and identified clinical risk markers including mechanical ventilation, antibiotic and antacid medications, performance of multiple procedures, and cardiac surgery. A threshold for platelet count associated with clinically significant bleeding in PICU patients was also identified, but other common laboratory tests of hemostasis had no association. We designed a prospective observational cohort study to further examine the association of laboratory tests with clinically significant bleeding. Platelet count was again associated with clinically significant bleeding, but the International Normalized Ratio (INR) and the activated Partial Thromboplastin Time (PTT) were not. This association was present even after adjustment for potentially confounding clinical variables. These results suggest that thrombocytopenia is an important and potentially modifiable risk factor for clinical significant bleeding in PICU patients