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Edme E, Sola C, Cau-Diaz I, Sirvent N, Mollevi C, Biron-Andreani C, Theron A. Gingival bleeding is a useful clinical feature in the diagnosis of hereditary bleeding disorders in children. Eur J Pediatr 2024; 183:2215-2221. [PMID: 38386030 DOI: 10.1007/s00431-024-05487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
The search for hereditary bleeding disorders (HBD) prior to invasive procedures in children is primarily based on personal and family bleeding history. Although several scores are available, they have only been evaluated in specific situations or in adults. Our monocentric retrospective study aimed to analyze the association between clinical history and four scores (HEMSTOP, PBQ, ISTH-BAT, TOSETTO) and the diagnosis of MHC in children referred to the University Hospital of Montpellier for hemostasis investigations. A total of 117 children were retrospectively included in the study. Of these, 57 (49%) were diagnosed with HBD, with 30 having primary bleeding disorders and 27 having coagulation disorders. The diagnosis of HBD was significantly associated with gingival bleeding, which was present in 30% of HBD patients. In our population, only the HEMSTOP score showed an association with the diagnosis of HBD, but it was positive in only 48% of patients. By including gingival bleeding as a factor, we modified the HEMSTOP score, which increased its sensitivity from 0.45 to 0.53. When examining primary bleeding disorders, the modified HEMSTOP score, with the inclusion of gingival bleeding, enables us to diagnose 63% of patients (see Fig. 1). Conclusion: Therefore, gingival bleeding should be considered a useful factor in bleeding history for HBD diagnosis. Adding this symptom to a screening score such as HEMSTOP improves its sensitivity. To confirm our findings, a prospective study is required. Trial registration: Study registration number: NCT05214300. What is Known: • Screening for hereditary bleeding disorder diseases is a necessity and a challenge in children. • Minor disorders of primary hemostasis are the most common, but often escape standard coagulation tests. What is New: • Gingival bleeding is a frequent symptom that is easy to investigate and may point to a primary hemostasis disorder. • Adding the gingival bleeding item to a routine screening score such as HEMSTOP improves sensitivity.
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Affiliation(s)
- Eleonore Edme
- Department of Pediatric Oncology and Hematology, Hôpital Arnaud de Villeneuve, Univ Montpellier, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Chrystelle Sola
- Department of Pediatric Anesthesia, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Cau-Diaz
- Department of Biological Hematology, Univ Montpellier, CHU Montpellier, Montpellier, France
- Hemophilia Treatment Center, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Sirvent
- Department of Pediatric Oncology and Hematology, Hôpital Arnaud de Villeneuve, Univ Montpellier, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Caroline Mollevi
- Institute Desbrest of Epidemiology and Public Health, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Christine Biron-Andreani
- Department of Biological Hematology, Univ Montpellier, CHU Montpellier, Montpellier, France
- Hemophilia Treatment Center, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Alexandre Theron
- Department of Pediatric Oncology and Hematology, Hôpital Arnaud de Villeneuve, Univ Montpellier, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France.
- Hemophilia Treatment Center, Univ Montpellier, CHU Montpellier, Montpellier, France.
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Zamudio Penko D, Cancho García D, Bartolomé Ruibal A, Gijón Herreros N, Redondo Martínez P, Gisbert de la Cuadra L, García Del Valle S. Preoperative coagulation screening tests in pediatric patients: Clinical relevance and hemorrhagic outcomes of abnormal results. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:68-76. [PMID: 36813028 DOI: 10.1016/j.redare.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/20/2021] [Indexed: 02/22/2023]
Abstract
PURPOSE Coagulation screening tests in children are still frequently performed in many countries to evaluate bleeding risk. The aim of this study was to assess the management of unexpected prolongations of the activated partial thromboplastin time (APTT) and prothrombine time (PT) in children prior to elective surgery, and the perioperative hemorrhagic outcomes. METHODS Children with prolonged APTT and/or PT who attended a preoperative anesthesia consultation from January 2013 to December 2018 were included. Patients were grouped according to whether they were referred to a Hematologist or were scheduled to undergo surgery without further investigation. The primary endpoint was to compare perioperative bleeding complications. RESULTS 1835 children were screened for eligibility. 102 presented abnormal results (5.6%). Of them, 45% were referred to a Hematologist. Significant bleeding disorders were associated with a positive bleeding history, odds ratio of 51 (95% CI 4.8-538.5, P=.0011). No difference in perioperative hemorrhagic outcomes were found between the groups. An additional cost of 181 euros per patient and a preoperative median delay of 43 days was observed in patients referred to Hematology. CONCLUSIONS Our results suggest that hematology referral has limited value in asymptomatic children with a prolonged APTT and/or PT. Hemorrhagic complications were similar among patients referred and not referred to Hematology. A positive personal or family bleeding history can help identify patients with a higher bleeding risk, thus it should guide the need for coagulation testing and hematology referral. Further efforts should be made to standardize preoperative bleeding assessments tools in children.
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Affiliation(s)
- D Zamudio Penko
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
| | - D Cancho García
- Departamento de Anestesiología, Hospital Universitario HM de Montepríncipe, Madrid. Spain
| | - A Bartolomé Ruibal
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - N Gijón Herreros
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - P Redondo Martínez
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - L Gisbert de la Cuadra
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - S García Del Valle
- Departamento de Anestesiología y Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Levy E, Kuperman A, Sela E, Kashkoush A, Miari AD, Hana RY, Freilich I, Bader A, Gruber M. Utility of the Pediatric Bleeding Questionnaire in Predicting Posttonsillectomy Bleeding. Otolaryngol Head Neck Surg 2021; 167:576-582. [PMID: 34813387 DOI: 10.1177/01945998211061474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE 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. STUDY DESIGN Prospective single-blinded cohort study. SETTING Tertiary care hospital system. METHODS 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. RESULTS 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]; P = .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]; P = .279). Sex was not found to be significant (odds ratio, 1.45 [95% CI, 0.70-3.18]; P = .343). CONCLUSIONS 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.
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Affiliation(s)
- Einat Levy
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amir Kuperman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel
| | - Eyal Sela
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Adham Kashkoush
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| | - Abeer Dabbah Miari
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| | - Randa Yawer Hana
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| | - Ieva Freilich
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| | - Ahmad Bader
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Maayan Gruber
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Masalha M, DeRowe A, Landsberg R, Mazzawi S, Shlizerman L, Kassem F, Fadel A. Is Postextracapsular Tonsillectomy Bleeding More Common on the Side of the Surgeon's Nondominant Hand? Otolaryngol Head Neck Surg 2021; 165:419-423. [PMID: 33399505 DOI: 10.1177/0194599820982636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the difference in bleeding when extracapsular tonsillectomy with electrocautery is performed on the dominant and nondominant side of the surgeon's hands. STUDY DESIGN Retrospective cohort study. SETTING Academic university hospital. METHODS Medical record data of patients who were admitted with posttonsillectomy bleeding from January 1, 2000, to July 31, 2017, were reviewed. Included were age, sex, surgical indication, side of posttonsillectomy bleeding, and time of bleeding. Information on the surgeon's dominant hand was also collected. All patients underwent total extracapsular resection with electrocautery. RESULTS Of 280 patients, 186 met the inclusion criteria, 116 (62.3%) males and 70 (37.7%) females. Ages ranged from 2 to 74 years (mean ± SD, 17 ± 13 years; median, 13 years). In 136 cases (73.1%), bleeding was on the side of the surgeon's nondominant hand (P < .0001). In 50 (26.9%) cases, bleeding was on the side of the surgeon's dominant hand. The odds ratio of bleeding on the side of the surgeon's nondominant hand compared to the dominant hand was 8.99. CONCLUSION The risk of bleeding following extracapsular tonsillectomy with electrocautery on the side of the surgeon's nondominant hand is significantly higher than on the side of the dominant hand. Thus, additional caution is required when operating on the nondominant side of the oral cavity in extracapsular tonsillectomy using electrocautery. These findings raise questions regarding dexterity as a risk factor for posttonsillectomy bleeding.
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Affiliation(s)
- Muhamed Masalha
- Department of Otolaryngology, Head and Neck Surgery, Emek Medical Center, Haifa, Afula, Israel.,Department of Otolaryngology, Head and Neck Surgery, Assuta Medical Center in Tel Aviv, Tel Aviv, Israel
| | - Are DeRowe
- Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Roee Landsberg
- Department of Otolaryngology, Head and Neck Surgery, Assuta Medical Center in Tel Aviv, Tel Aviv, Israel
| | - Salim Mazzawi
- Department of Otolaryngology, Head and Neck Surgery, Emek Medical Center, Haifa, Afula, Israel
| | - Lev Shlizerman
- Department of Otolaryngology, Head and Neck Surgery, Emek Medical Center, Haifa, Afula, Israel
| | - Firas Kassem
- Department of Otolaryngology, Head and Neck Surgery, Meir Medical Center in Kfar Saba, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Adam Fadel
- Department of Otolaryngology, Head and Neck Surgery, Emek Medical Center, Haifa, Afula, Israel
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