Epidemiology of preoperative hematologic assessment of children cared for in a pediatric emergency department.
OBJECTIVE
To assess frequency of preoperative hematologic testing in a tertiary care pediatric emergency department (PED) and how often these values predict clinical outcome or change management decisions.


METHODS
Single-center retrospective cohort study in a tertiary-care children's hospital PED. Patients 0-18years old, presenting between July 1, 2009-July 1, 2011, ultimately undergoing a surgical procedure within 48h of presentation were included. Patients were defined as having "preoperative" hematologic assessment if these studies were performed solely because the child was going to the operative suite. Patients who met trauma team activation criteria, underwent neurosurgical procedures, or had laboratory studies performed prior to PED arrival were excluded. The primary outcome was the prevalence of preoperative laboratory assessment.


RESULTS
528 children were included, of whom 301 (57%) underwent preoperative hematologic laboratory evaluations. Of these 301 patients, 115 (38%) had abnormal hematologic parameters, and only 3 (1%) of these patients had their perioperative management changed. One additional child had intraoperative bleeding that required blood products but did not undergo preoperative hematologic assessment. All four children had medical histories that would have identified their risk for perioperative bleeding events.


CONCLUSION
Preoperative hematologic laboratory assessment occurs frequently in children initially cared for in a tertiary care pediatric emergency department who subsequently undergo operative interventions. Although age-based abnormal hematologic values are often found, rarely are these abnormalities clinically significant. This study suggests that children cared for in a PED without a history concerning for an increased risk of perioperative bleeding does not require preoperative hematologic assessment.
['Woll|Christopher|C|', 'Smith|P Brian|PB|', 'Fox|James Walter|JW|']
D000293:Adolescent D002648:Child D002675:Child, Preschool D004636:Emergency Service, Hospital D005260:Female D006403:Hematologic Tests D006776:Hospitals, Pediatric D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D010372:Pediatrics D011300:Preoperative Care D012189:Retrospective Studies D014481:United States
Preoperative Hematology Pediatric Emergency Coagulation Screening