Keidan Ilan, Elbaz Uri, Bilik Ron, Berkenstadt Haim, Avigad Etamar, Segal Eran
Pediatric Anesthesia Unit, Department of Anesthesia and Intensive Care, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Harefuah. 2003 Sep;142(8-9):597-9, 647, 646.
This study was designed to evaluate the current practice of preoperative laboratory testing in healthy children undergoing elective surgery in a single tertiary general hospital, and compare it to the guidelines published by the American and Israeli societies of pediatric anesthesia. We also evaluated the effects of a pre-designed educational program on that practice. This was a prospective, two stage study. In stage one, data was collected on the practice of the preoperative laboratory tests obtained from children scheduled for elective surgeries. We then conducted training, dedicated to criteria and indications for preoperative laboratory testing in children prior to elective surgery. Following the training, we conducted a second phase observation and data on a second group of children was collected and analyzed. Comparing the two groups of children enabled the evaluation of the benefit of the pre-designed educational program. Two hundred and forty children scheduled for elective surgery during the four months of the study period, were surveyed. In stage one, we enrolled and documented preoperative laboratory data obtained for 150 children. In stage two, we collected data on 90 children. Overall, the incidence of unnecessary laboratory tests in the preoperative period was reduced significantly (by 32.5%, p < 0.001). The incidence of non-indicated tests performed, was also reduced significantly (by 23.1%, P = 0.015). We conclude that the use of unnecessary testing of children before elective surgery is common. A training program designed to address this issue can lead to a reduction in unnecessary testing.
本研究旨在评估一家三级综合医院中接受择期手术的健康儿童术前实验室检查的当前做法，并将其与美国和以色列儿科麻醉学会发布的指南进行比较。我们还评估了一个预先设计的教育项目对这种做法的影响。这是一项前瞻性的两阶段研究。在第一阶段，收集了计划接受择期手术儿童的术前实验室检查做法的数据。然后，我们针对择期手术前儿童术前实验室检查的标准和适应症进行了培训。培训后，我们进行了第二阶段的观察，并收集和分析了第二组儿童的数据。比较两组儿童有助于评估预先设计的教育项目的益处。在研究期间的四个月内，对240名计划接受择期手术的儿童进行了调查。在第一阶段，我们登记并记录了150名儿童的术前实验室数据。在第二阶段，我们收集了90名儿童的数据。总体而言，术前不必要实验室检查的发生率显著降低（降低了32.5%，p<0.001）。未进行的非适应症检查的发生率也显著降低（降低了23.1%，P=0.015）。我们得出结论，择期手术前对儿童进行不必要的检查很常见。旨在解决这一问题的培训项目可以减少不必要的检查。
