Epidemiology of preoperative hematologic assessment of children cared for in a pediatric emergency department

Objective: To assess frequency of preoperative hematologic testing in a tertiary care pediatric emergency department (PED) and how often these values predict clinical outcome or change management decisions. Methods: Single-center retrospective cohort study in a tertiary-care children's hospital PED. Patients 0-18 years old, presenting between July 1, 2009-July 1, 2011, ultimately undergoing a surgical procedure within 48 h of presentation were included. Patientswere defined as having "preoperative" hematologic assessment if these studies were performed solely because the childwas going to the operative suite. Patients who met trauma teamactivation criteria, underwent neurosurgical procedures, or had laboratory studies performed prior to PED arrivalwere excluded. The primary outcome was the prevalence of preoperative laboratory assessment. Results: 528 childrenwere included, of whom 301 (57%) underwent preoperative hematologic laboratory evaluations. Of these 301 patients, 115 (38%) had abnormal hematologic parameters, and only 3 (1%) of these patients had their perioperative management changed. One additional child had intraoperative bleeding that required blood products but did not undergo preoperative hematologic assessment. All four children hadmedical histories that would have identified their risk for perioperative bleeding events. Conclusion: Preoperative hematologic laboratory assessment occurs frequently in children initially cared for in a tertiary care pediatric emergency departmentwho subsequently undergo operative interventions. Although agebased abnormal hematologic values are often found, rarely are these abnormalities clinically significant. This study suggests that children cared for in a PEDwithout a history concerning for an increased risk of perioperative bleeding does not require preoperative hematologic assessment. (C) 2017 Elsevier Inc. All rights reserved.