Evaluation of the International Society on Thrombosis and Haemostasis and institutional diagnostic criteria of disseminated intravascular coagulation in pediatric patients

Am J Clin Pathol. 2013 Jun;139(6):812-6. doi: 10.1309/AJCPO64IWNLYCVVB.


Globally, adult intensive care units routinely use the International Society on Thrombosis and Haemostasis (ISTH) scoring system for identifying overt disseminated intravascular coagulation (DIC). However, in our pediatric intensive care unit, a modified diagnostic criterion (Texas Children's Hospital [TCH] criteria) that requires serial monitoring of the coagulation variables is employed. A retrospective analysis of 2,136 DIC panels from 130 patients who had at least 4 DIC panels during 1 admission to a pediatric intensive care unit was done to compare the diagnostic utility of the TCH criteria with the ISTH scoring method in children. Both scoring systems were evaluated against the gold standard diagnostic method of autopsy confirmation of DIC in the subset of children who died. Receiver operating characteristic analysis indicates that TCH diagnostic criteria are comparable to the ISTH scoring method (area under the curve of 0.878 for TCH and 0.950 for ISTH). On the contrary, TCH diagnostic criteria perform better, with a sensitivity significantly higher than the ISTH scoring method when tested against the gold standard (P < .05). Fibrinogen is not a significant predictor of overt DIC in both models. Sequential testing of coagulation parameters is recommended for improved sensitivity when applying ISTH criteria to pediatric populations.

Keywords: Autopsy; Children; DIC score; Disseminated intravascular coagulation; International Society on Thrombosis and Haemostasis (ISTH).

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Algorithms
  • Area Under Curve
  • Autopsy
  • Blood Coagulation Tests / standards*
  • Child
  • Child, Preschool
  • Disseminated Intravascular Coagulation / blood
  • Disseminated Intravascular Coagulation / diagnosis*
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Fibrinogen
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units
  • Male
  • Platelet Count
  • Prothrombin Time
  • ROC Curve
  • Retrospective Studies
  • Sensitivity and Specificity


  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Fibrinogen