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Utility of the Pediatric Bleeding Questionnaire in Predicting Posttonsillectomy Bleeding
Einat Levy1,2, Amir Kuperman2,3, Eyal Sela1,2
1Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.
Insights
The Pediatric Bleeding Questionnaire (PBQ) can identify children at higher risk for post-tonsillectomy bleeding. A PBQ score of 2 or more is more effective than traditional coagulation tests in predicting bleeding complications.
Area of Science:
- Pediatric Surgery
- Hematology
- Clinical Diagnostics
Background:
- Post-tonsillectomy bleeding is a serious complication.
- Preoperative coagulation tests are ineffective in predicting bleeding risk.
Purpose of the Study:
- To evaluate the Pediatric Bleeding Questionnaire (PBQ) as a preoperative screening tool for post-tonsillectomy bleeding in children.
Main Methods:
- Prospective single-blinded cohort study involving 272 children undergoing tonsil surgery.
- Caregivers completed the PBQ preoperatively; all children had coagulation tests.
Main Results:
- A PBQ score of ≥2 correlated with increased postoperative bleeding risk (OR, 10.018; P = .046).
- The PBQ showed better predictive ability than coagulation tests (OR, 1.76; P = .279).
Conclusions:
- The PBQ is a valuable tool for identifying children at risk of post-tonsillectomy bleeding.
- A PBQ score of ≥2 offers a higher yield than coagulation studies for risk detection.
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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