title: Epidemiology of Bleeding in Critically Ill Children.
abstract: To determine the epidemiology of bleeding in critically ill children.
  
  
  
  We conducted a cohort study of children <18 years old admitted to the pediatric intensive care unit for >24 hours and without clinically relevant bleed (CRB) on admission. CRB was defined as resulting in severe physiologic derangements, occurring at a critical site or requiring major therapeutic interventions. Using a novel bleeding assessment tool that we developed, characteristics of the CRB were abstracted from the medical records independently and in duplicate. From the cohort, we matched each child with CRB to 4 children without CRB based on onset of CRB. Risk factors and complications of CRB were identified from this matched group of children.
  
  
  
  We analyzed 405 children with a median age of 35 months (IQR 7-130 months). A total of 37 (9.1%) children developed CRB. The median number of days with CRB was 1 day (IQR 1-2 days). Invasive ventilation (OR 61.35; 95% CI 6.27-600.24), stress ulcer prophylaxis (OR 2.70; 95% CI 1.08-6.74), surgical admission (OR 0.29; 95% CI 0.10-0.84), and aspirin (OR 0.04; 95% CI 0.002-0.58) were associated with CRB. CRB was associated with longer time to discharge from the unit (hazard ratio 0.20; 95% CI 0.13-0.33) and the hospital (hazard ratio 0.49; 95% CI 0.33-0.73). Children with CRB were on vasopressor longer and transfused more red blood cells after the CRB than those without CRB.
  
  
  
  Our findings suggest that bleeding complicates critical illness in children.
authors.affiliation: Department of Pediatrics, Yale-New Haven Children's Hospital, New Haven, CT.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: White
authors.affiliation: Department of Pediatrics, Yale-New Haven Children's Hospital, New Haven, CT.
authors.forename: Ryan
authors.initials: R
authors.lastname: Fredericks
authors.affiliation: Department of Pediatrics, Yale-New Haven Children's Hospital, New Haven, CT.
authors.forename: Candace N
authors.initials: CN
authors.lastname: Mannarino
authors.affiliation: Department of Pediatrics, Yale-New Haven Children's Hospital, New Haven, CT.
authors.forename: Stephen
authors.initials: S
authors.lastname: Janofsky
authors.affiliation: Department of Pediatrics, Yale School of Medicine, New Haven, CT. Electronic address: vince.faustino@yale.edu.
authors.forename: Edward Vincent S
authors.initials: EVS
authors.lastname: Faustino
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male
keywords: hemorrhage; hemostasis; intensive care unit; mechanical ventilation; stress ulcer prophylaxis