title: Is haemostasis biological screening always useful before performing a neuraxial blockade in children?
abstract: BACKGROUND
  Because of the lack of controlled studies, there is no consensus of opinion about the practice of routine haemostasis tests before neuraxial blockade in children. The purpose of this study was to compare the influence of two different strategies of coagulation evaluation on the incidence of diagnosed coagulopathies leading to a modification of the preoperative or anaesthetic management in children who were scheduled for caudal, epidural or intrathecal block.
  
  
  METHODS
  For a 24-month period (period 1, retrospective study, n=751), haemostasis screening was undertaken only after family and personal history and physical examination in all patients. For the following 24 months (period 2, prospective study, n=958), a standardized questionnaire was used. In addition, routine tests (prothrombin, partial thromboplastin time, platelet count) were performed in children who where not yet walking. In older children, coagulation tests were undertaken as in period 1.
  
  
  RESULTS
  Overall, 26 significant abnormalities were diagnosed. Coagulation tests were performed in 16.2% (period 1) and 78.2% (period 2) of the children, who were not yet walking. Routine tests did not improve the diagnosis of haemostasis abnormalities justifying a modification of the preoperative and anaesthetic management (2.2% from 406 children in period 1 vs 4.1% from 266 children in period 2). The predictive positive value of routine tests (period 2) was 19%, vs 45% for specific tests (period 1) (P < 0.001). In older children, the use of a standardized form increased the number of haemostasis screenings without improvement of diagnosis leading to modified preoperative management (0.3% from 315 children in period 1 vs 0.5% from 628 children in period 2).
  
  
  CONCLUSIONS
  When routine testing is performed in nonwalking children, the screening number increases without leading to a higher number of anaesthetic management changes, suggesting that routine testing does not seem to provide much extra information in the absence of a positive history.
authors.affiliation: Department of Anaesthesiology, Hôtel Dieu, CHU Nantes, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Le Roux
authors.forename: Corinne
authors.initials: C
authors.lastname: Lejus
authors.forename: Marielle
authors.initials: M
authors.lastname: Surbleb
authors.forename: Mariette
authors.initials: M
authors.lastname: Renaudin
authors.forename: Christian
authors.initials: C
authors.lastname: Guillaud
authors.forename: Ariane
authors.initials: A
authors.lastname: de Windt
authors.forename: Betty
authors.initials: B
authors.lastname: Lasnier
authors.forename: Michel
authors.initials: M
authors.lastname: Pinaud
mesh_terms: D000765:Anesthesia, Conduction; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000453:epidemiology; D001780:Blood Coagulation Tests; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008403:Mass Screening; D009407:Nerve Block; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies