Characteristics of children diagnosed as having coagulopathies following posttonsillectomy bleeding.

OBJECTIVE

To determine the prevalence of coagulopathy among children presenting with posttonsillectomy bleeding (PTB) and describe risk factors that could indicate the presence of occult coagulopathy.

DESIGN

Retrospective medical chart review.

SETTING

Tertiary-care pediatric hospital.

PATIENTS

The study population comprised 182 patients presenting with PTB from January to December 2007.

MAIN OUTCOME MEASURES

Demographics, laboratory studies, type of intervention, transfusion status, need for hematology consultation, type of coagulopathy, and disposition were recorded.

RESULTS

There were 216 emergency department (ED) encounters for PTB. The mean age of the patients was 8.4 years, and 56% were male and 79% were white. Patients presented on mean postoperative day 5.9. Of the 182 children, 34 (19%) presented with abnormally elevated prothrombin time, activated partial thromboplastin time, or platelet function assays (PFAs) for both adenosine diphosphate and epinephrine. Eight patients (4%) ultimately were diagnosed as having a coagulopathy. Differences in mean age (P = .23), sex (P = .47), race (P = .76), number of days posttonsillectomy (P = .34), and higher ED visit frequency (P = .06) between the coagulopathic and noncoagulopathic children were not statistically significant. Coagulopathic children had significantly higher mean activated partial thromboplastin time (P < .001), PFA for adenosine diphosphate (P < .001), and PFA for epinephrine (P = .001). Of the 8 coagulopathic children, 3 (38%) presented with a history of oral bleeding and a normal physical examination.

CONCLUSIONS

In children presenting with PTB, activated partial thromboplastin time and PFA studies and hematology consultations are helpful in identifying occult coagulopathies. The definition of PTB should be broadened to include children with any history of oral bleeding, regardless of examination findings.