Developmental Coordination Disorder Plus: A Diagnosis by Exclusion?

CASE: Cayden is a 6.3-year-old boy who you have been following in our practice since birth. He was born at 35.5 weeks at 6 pounds 4 ounces following a fraternal twin gestation. Both children were "on target" with their milestones, but Cayden did not seem to progress as quickly as his sister. He did not initiate play with his sister when they were toddlers and Cayden was the "shy" one.

Developmental coordination disorder plus: a diagnosis by exclusion?

CASE: Cayden is a 6.3-year-old boy who you have been following in our practice since birth. He was born at 35.5 weeks at 6 pounds 4 ounces following a fraternal twin gestation. Both children were "on target" with their milestones, but Cayden did not seem to progress as quickly as his sister. He did not initiate play with his sister when they were toddlers and Cayden was the "shy" one.

Use of a preoperative bleeding questionnaire in pediatric patients who undergo adenotonsillectomy.

OBJECTIVE: To determine the efficacy of a preoperative bleeding questionnaire (POBQ) and coagulation screening in predicting hemorrhage associated with adenotonsillectomy. STUDY DESIGN: Retrospective study. SUBJECTS AND METHODS: Between January 1998 and December 2003, 7730 tonsillectomy and adenotonsillectomy patients were administered the POBQ preoperatively. Further coagulation screening was based on POBQ responses. RESULTS: A total of 232 (3.0%) of 7730 had postoperative bleeding; 184 (3.2%) of 5782 patients who had negative questionnaires bled postoperatively compared with 48 (2.5%) of 1948 patients with positive questionnaires (P = 0.126). Of 1948 patients with positive questionnaires, 141 (7.2%) had abnormal preoperative coagulation screens and 9 (6.4%) of 141 bled; of the 1807 (92.8%) with negative coagulation screens, 39 (2.2%) bled (P = 0.005). CONCLUSION: The POBQ is an effective tool for identifying patients who are at potential risk for post-tonsillectomy bleeding. Patients with both a positive POBQ and coagulation screen had a statistically higher likelihood of postoperative bleeding than other patients. The POBQ allowed the identification of individuals with bleeding disorders to be treated before surgery, likely decreasing the risk of bleeding in these patients.