Hematologic Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Abstract

Context: Studies of organ dysfunction in children are limited by a lack of consensus around organ dysfunction criteria.

Objectives: To derive evidence-informed, consensus-based criteria for hematologic dysfunction in critically ill children.

Data sources: Data sources included PubMed and Embase from January 1992 to January 2020.

Study selection: Studies were included if they evaluated assessment/scoring tools to screen for hematologic dysfunction and assessed outcomes of mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies of adults or premature infants, animal studies, reviews/commentaries, small case series, and non-English language studies with inability to determine eligibility were excluded.

Data extraction: Data were abstracted from each eligible study into a standard data extraction form along with risk of bias assessment.

Results: Twenty-nine studies were included. The systematic review supports the following criteria for hematologic dysfunction: thrombocytopenia (platelet count <100000 cells/µL in patients without hematologic or oncologic diagnosis, platelet count <30000 cells/µL in patients with hematologic or oncologic diagnoses, or platelet count decreased ≥50% from baseline; or leukocyte count <3000 cells/µL; or hemoglobin concentration between 5 and 7 g/dL (nonsevere) or <5 g/dL (severe).

Limitations: Most studies evaluated pre-specified thresholds of cytopenias. No studies addressed associations between the etiology or progression of cytopenias overtime with outcomes, and no studies evaluated cellular function.

Conclusions: Hematologic dysfunction, as defined by cytopenia, is a risk factor for poor outcome in critically ill children, although specific threshold values associated with increased mortality are poorly defined by the current literature.