An evidence-based threshold for thrombocytopenia associated with clinically significant bleeding in pediatric intensive care unit patients

Objective: To determine the epidemiology and identify the risk factors for clinically significant bleeding in the pediatric intensive care unit. Design: A retrospective cohort study over 6 months with up to 7 days of observation for each patient. Setting: The pediatric intensive care unit in a tertiary care children's hospital. Patients: Three hundred twenty-six consecutive patients admitted to the pediatric intensive care unit during the study period, with 214 eligible for inclusion. Measurements and Main Results: Clinically significant bleeding, defined using a composite of outcomes. Clinically significant bleeding occurred in 19 patients (8.9%). Recursive partitioning identified a platelet count <100 x 10(9)/L as being associated with clinically significant bleeding. Other factors associated with increased risk included mechanical ventilation, antibiotic and antacid medications, the performance of multiple procedures, and cardiac surgery. Episodes of clinically significant bleeding were observed at a median of 9.8 hrs after admission. Conclusions: Clinically significant bleeding is a more common complication for pediatric intensive care unit patients than has been previously reported. The evidence-based threshold for thrombocytopenia identified as a risk factor should be further investigated in a prospective study. (Pediatr Crit Care Med 2012;13:e316-e322)