• Marianne E Nellis, Julie Levasseur, Judy Stribling, Faustino E Vincent S EVS Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT., Nicole D Zantek, Sujit Sheth, and Oliver Karam.
• Pediatric Critical Care Medicine, Department of Pediatrics, New York Presbyterian Hospital - Weill Cornell Medicine, New York, NY.
• Pediatr Crit Care Me. 2019 Jul 1; 20 (7): 603-607.

ObjectivesTo summarize current bleeding scales and their validation to assess applicability to bleeding in critically ill children.Data SourcesWe conducted electronic searches of Ovid MEDLINE, Ovid EMBASE, Cochrane Library, and Web of Science Core Collection databases from database inception to 2017.Study SelectionIncluded studies contained a bleeding score, bleeding measurement tool, or clinical measurement of hemorrhage.Data ExtractionWe identified 2,097 unique citations; 20 full-text articles were included in the final review.Data SynthesisOf 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.ConclusionsThere 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.

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