Utility of the Pediatric Bleeding Questionnaire in Predicting Posttonsillectomy Bleeding.

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.

The effect of an interventional program on the occurrence of medication errors in children.

OBJECTIVES: Medication errors in hospitalized children represent a serious health problem; these include dosing errors, administration route errors, errors in identifying the patient and more. The rates of medication errors are considered higher in children compared to adults because, among other reasons, the pediatric dose is calculated according to the child's weight or body surface. This study aims to examine the incidence of pediatric medication dosing errors and the impact of an intervention program in reducing these errors and related adverse effects in a cohort of hospitalized children at an otolaryngology department. METHODS: We reviewed 100 computerized medical reports of hospitalized children from 2017 to 2018, including 50 inpatient admissions prior to the implementation of an intervention program and 50 inpatient admissions following its implementation. Data includes demographic variables, number of hospitalization days, rates and types of medication errors and adverse effects. We have analyzed the rates of medication errors before and after implementation of an interventional program. RESULTS: The average patient age was 5.26 and the demographic features of the two groups were similar. We identified 23.2% medication dosing errors in medications prescribed to the patients (n = 33) and 17.6% medication dosing errors in total medications administered to the patients (n = 64) in the pre-intervention group (PREG). In the post-intervention group (POSG) we identified 10.6% medication dosing errors in prescriptions prescribed to the patients (n = 12) and 7% medication dosing errors in the total drugs administered to the patients (n = 21). The intervention program resulted in 46% reduction of prescription errors; No adverse effects were recorded. CONCLUSIONS: Medication dosing errors among hospitalized children are common, although rates of adverse events are low. The suggested intervention program demonstrates a significant reduction in the rates of these errors, thus improving the safety of hospitalized children.