The need for routine pre-operative coagulation screening tests (prothrombin time PT/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy.
In some medical centers, the routine pre-operative evaluation of healthy children undergoing elective tonsillectomy and/or adenoidectomy (T and A) includes coagulation screening tests (PT, prothrombin Time; PTT, partial thromboplastin time; and INR, international normalized ratio). In this retrospective study, we determined whether there is a positive correlation between prolonged PT/PTT/INR tests in healthy children, with no prior medical history of coagulation problems, and bleeding during surgery and/or bleeding in the month following surgery. We reviewed the records of 416 elective T and A surgeries performed at the Soroka University Medical Center in Beer-Sheva, Israel, over the course of 1999. One hundred and twenty-one (29.1%) patients had preoperative prolonged PT values but only four (3.3%) of these patients experienced light bleeding during surgery. Seven (5.8%) of the 121 patients with prolonged PT tests experienced bleeding episodes during the 1st month subsequent to the surgery. Of the 65 (15.6%) patients who had prolonged pre-operative INR values, only three (4.6%) experienced light bleeding during surgery. Two (3.1%) patients with prolonged INR values experienced light bleeding during the 1st month subsequent to surgery. Sixty-one (14.7%) patients had prolonged first preoperative PTT values, only five of whom (8.2%) experienced light bleeding during surgery. Two (3.3%) of the 61 with prolonged PTT values experienced light bleeding during the 1st month subsequent to surgery. We therefore concluded that pre-operative coagulation screening tests provide low sensitivity and low bleeding predictive value. As such, routine coagulation tests before T &A are not indicated unless a medical history of bleeding tendency is suspected.
Asaf
T
T
Pediatric Hemato-Oncology Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel.
Reuveni
H
H
Yermiahu
T
T
Leiberman
A
A
Gurman
G
G
Porat
A
A
Schlaeffer
P
P
Shifra
S
S
Kapelushnik
J
J
D000233:Adenoidectomy / Q000009:adverse effects*; D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000175:diagnosis*; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D010314:Partial Thromboplastin Time; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011517:Prothrombin Time; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000009:adverse effects*; D014069:Tonsillitis / Q000601:surgery*; D016896:Treatment Outcome