Preoperative screening for coagulation disorders in children undergoing adenoidectomy (AT) and tonsillectomy (TE): does it prevent bleeding complications?
BACKGROUND
Bleeding remains the most important complication of adenotonsillectomy in children. Preoperative coagulation tests are widely used to detect unknown bleeding disorders. To determine the efficacy of preoperative coagulation screening in preventing bleeding complications.


METHODS
Study group 1: 148 healthy children referred by the otorhinolaryngology department for preoperative pediatric examination. Study group 2: 124 healthy children sent to the hemostaseologic clinic for preoperative investigation of a prolonged PTT.


METHODS
The incidence of relevant coagulation disorders detected by a standardized bleeding history and coagulation screening tests was studied prospectively in 2 study groups planned for AT and/or TE. The frequency of abnormal bleeding was investigated retrospectively in those children who underwent surgery.


RESULTS
Bleeding disorders were detected in 7/148 and 15/124 children in study group 1 and 2 respectively. 141/148 and 79/124 children actually underwent surgery, 62 TE +/- AT + 79 AT alone and 26 TE +/- AT + 53 AT alone respectively. Major bleeding occurred in 1/141 patients (1 TE) in study group 1. Preoperatively, this child had shown normal coagulation screening tests. In 4/79 patients (3 TE, 1 AT) in study group 2, surgery was complicated by major bleeding. Despite extensive testing, no relevant bleeding disorder had been diagnosed in these children preoperatively. Sensitivity of coagulation screening tests for major bleeding was 0 in study group 1.


CONCLUSIONS
In our study, coagulation screening failed to effectively identify patients at risk of bleeding.
Eisert
S
S
Department of Pediatric Oncology, Hematology and Immunology, Children's University Hospital, Heinrich Heine University Düsseldorf. susanne.eisert@uni-duesseldorf.de
Hovermann
M
M
Bier
H
H
Göbel
U
U
D000233:Adenoidectomy; D000293:Adolescent; D000367:Age Factors; D001778:Blood Coagulation Disorders / Q000175:diagnosis*; D001780:Blood Coagulation Tests; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014068:Tonsillectomy