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Original Research

Program: Section on Emergency Medicine

P2B059: The Utility of Preoperative Coagulation Studies for Emergent Pediatric Procedures

Saturday, October 21, 2023
1:15 PM – 2:15 PM US EDT
Location: Walter E. Washington Convention Center, Exhibit Hall A
Poster Presentation
Background: The American Academy of Pediatrics (AAP) 2014 policy statement regarding preoperative clearance for non-emergent procedures discourages obtaining routine laboratory studies. Despite this recommendation, there is considerable variation in obtaining preoperative tests. A recent meta-analysis concluded that there is currently inadequate data to support or refute routine coagulopathy screening for emergent surgical procedures. The objective of this study is to examine the utility of preoperative coagulopathy screening for children undergoing emergent surgical procedures.

Methods: We conducted a retrospective chart review of pediatric patients < 21 years old admitted from the emergency departments (EDs) across the 11 hospitals in the NYC Health + Hospitals system from January 2018 through October 2020. The medical records of patients with either appendicitis or cholecystitis who had coagulation studies (INR, PTT, and platelet count) were included. Patients at risk for bleeding due to medication or medical history were excluded.

Demographics and ED diagnoses were collected. Patients with any abnormal coagulation study (INR > 1.2, PTT > 36.7 seconds, or platelets < 130,000/µL) were reviewed to determine if the abnormal labs were repeated, surgery was delayed or canceled, further coagulopathy workup or hematology consult were required, or if there were any postoperative complications.

Continuous data were reported as means (+/- SD), and categorical data were reported as frequencies (percentages).

Results: A total of 1069 patients had diagnoses of appendicitis or cholelithiasis. Of these, 513 (48%) patients had complete coagulation studies performed and were included in the analysis. The median age was 15.6 years (+/- 4.8); 274 (53%) patients were male. There were 162 patients (32%) with abnormal coagulation studies (119 with abnormal INR, 31 with abnormal PTT, and 12 with more than one abnormal value). Of these patients, 122 (75%) had surgery performed, 12 (8%) had the labs repeated, 2 (1%) had a coagulopathy workup, 1 (0.6%) was identified during prescreening by anesthesiology as having a bleeding disorder, 1 (0.6%) had a postoperative bleed. No patients had their procedure canceled due to abnormal coagulation studies.

Conclusion: While coagulation studies were abnormal almost 1/3 of the time, there was no change in surgical management in our study population. Our findings suggest that preoperative coagulopathy screening is not necessary for emergent procedures. The AAP may expand routine preoperative screening recommendations to include emergent and non-emergent procedures