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 ch ildren undergoing elective tonsillectomy and/or adenoidectomy (T and A) inc ludes coagulation screening tests (PT, prothrombin Time; PTT, partial throm boplastin time. and INR, international normalized ratio). In this retrospec tive study, we determined whether there is a positive correlation between p rolonged PT/PTT/INR tests in healthy children, with no prior medical histor y of coagulation problems, and bleeding during surgery and/or bleeding in t he 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%) patien ts had preoperative prolonged PT values but only four (3.3%) of these patie nts experienced light bleeding during surgery. Seven (5.8%) of the 121 pati ents with prolonged PT tests experienced bleeding episodes during the Ist m onth subsequent to the surgery. Of the 65 (15.6%) patients who had prolonge d pre-operative INR values, only three (4.6%) experienced light bleeding du ring surgery. Two (3.1%) patients with prolonged INR values experienced lig ht bleeding during the Ist month subsequent to surgery. Sixty-one (14.7%) p atients had prolonged first preoperative PTT values. only five of whom (8.2 %) experienced light bleeding during surgery. Two (3.3%) of the 61 with pro longed PTT values experienced light bleeding during the Ist month subsequen t to surgery. We therefore concluded that pre-operative coagulation screeni ng tests provide low sensitivity and low bleeding predictive value. As such , routine coagulation tests before T&A are not indicated unless a medical h istory of bleeding tendency is suspected. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.