Preoperative screening for coagulopathy in elective neurosurgical patients in Wellington Regional Hospital and survey of practice across Australia and New Zealand

Things We Do for No Reason™: Routine preoperative hemostatic testing for neurosurgical procedures

“…Last, preoperative hemostatic testing may lead to costly and wasteful spending 3,5,6 . Using estimates from the Healthcare Bluebook, a validated open‐access online service with nationally representative cost estimates for medical tests and procedures, the average costs for these tests are $11 ($6‐$28) per INR, $11 ($6–$28) per aPTT, and $14 ($7–$35) per complete blood count, totaling approximately $44 for all three tests per patient 7 .…”

“…Instead of routine preoperative hemostatic screening, obtaining a thorough clinical history identifies the majority of abnormal coagulation profiles and provides a more cost‐effective process to predict bleeding complications 2–6,8,9 . A pertinent history should include (1) the presence of hemorrhagic symptoms or abnormal bleeding (prolonged epistaxis, tendency to develop bruises, etc.…”

“…Importantly, data garnered from routine blood coagulation studies rarely affect clinical decision‐making. In a study including 1143 patients undergoing elective neurosurgeries including “cranial, spinal, and peripheral nerve operations,” Harley et al found that six patients (0.5%) had abnormal coagulation profiles not identified by their history 5 . None of the six patients with unexpected coagulation profiles received corrective preoperative treatment or a repeat coagulation study.…”

“…Last, preoperative hemostatic testing may lead to costly and wasteful spending. 3,5,6 Using estimates from the Healthcare Blue-…”

Machine learning models predict coagulopathy in spontaneous intracerebral hemorrhage patients in ER

“…Previously, clinical parameters, including age, gender, body temperature, have been identified as risk factors for coagulation abnormalities in acute ICH patients, yet the sensitivities and specificities varied among studies. [10][11][12][13][14][15] The difficulties of precise predictions come from the fact that the coagulopathy during the acute phase of ICH is a multifactorial pathological process with complex mechanisms, possibly including tissue damage, hypoxemia, acidemia, inflammation, hypoperfusion, and other confounders. For ICH patients arriving at the ER, it is impractical for clinicians to screen every individual factor.…”