Levy Einat, Kuperman Amir, Sela Eyal, Kashkoush Adham, Miari Abeer Dabbah, Hana Randa Yawer, Freilich Ieva, Bader Ahmad, Gruber Maayan
Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Otolaryngol Head Neck Surg. 2022 Sep;167(3):576-582. doi: 10.1177/01945998211061474. Epub 2021 Nov 23.
Posttonsillectomy bleeding is a dreadful complication that may be life-threatening. Preoperative coagulation tests have not been shown to be effective in predicting this complication. The Pediatric Bleeding Questionnaire (PBQ) is a validated and sensitive tool in diagnosing children with abnormal hemostatic functions, and the objective of our study was to assess its utility as a preoperative screening tool for predicting posttonsillectomy bleeding.
Prospective single-blinded cohort study.
Tertiary care hospital system.
All children scheduled for tonsil surgery between 2017 and 2019 in the Galilee Medical Center were included. The PBQ was completed by the caregivers prior to surgery, and all children underwent coagulation tests. Each PBQ item is scored on a scale of -1 to 4, and the total score per candidate is based on summation of all items.
An overall 272 patients were included in the study with a mean age of 5.2 years; 57.7% were boys. The main finding was that in a multivariable model adjusted to age, a PBQ score of 2 is correlated with increased postoperative bleeding risk (odds ratio, 10.018 [95% CI, 1.20-82.74]; = .046). The results of the PBQ demonstrated better predictive ability when compared with abnormal coagulation test results (odds ratio, 1.76 [95% CI, 0.63-4.80]; = .279). Sex was not found to be significant (odds ratio, 1.45 [95% CI, 0.70-3.18]; = .343).
This study demonstrated that a PBQ score ≥2 has a higher yield for detecting children at risk for posttonsil surgery bleeding as compared with coagulation studies.
扁桃体切除术后出血是一种可怕的并发症，可能危及生命。术前凝血检查尚未显示出能有效预测这一并发症。儿童出血问卷（PBQ）是诊断止血功能异常儿童的一种经过验证且敏感的工具，我们研究的目的是评估其作为预测扁桃体切除术后出血的术前筛查工具的效用。
前瞻性单盲队列研究。
三级医疗医院系统。
纳入2017年至2019年在加利利医疗中心计划进行扁桃体手术的所有儿童。护理人员在手术前完成PBQ，所有儿童均接受凝血检查。PBQ的每个项目评分为-1至4分，每个候选者的总分基于所有项目的总和。
本研究共纳入272例患者，平均年龄5.2岁；57.7%为男孩。主要发现是，在根据年龄调整的多变量模型中，PBQ评分为2与术后出血风险增加相关（比值比，10.018[95%CI，1.20 - 82.74]；P = 0.046）。与异常凝血检查结果相比，PBQ结果显示出更好的预测能力（比值比，1.76[95%CI，0.63 - 4.80]；P = 0.279）。未发现性别具有显著性（比值比，1.45[95%CI，0.70 - 3.18]；P = 0.343）。
本研究表明，与凝血研究相比，PBQ评分≥2在检测扁桃体手术后出血风险儿童方面具有更高的检出率。
