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

4 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


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

PubMed: MeSH publication types

  • Journal Article
  • Systematic Review


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