Meryem ALBAYRAK, Hülya BAŞAR, Şule TOPRAK, Cihat ŞANLI, Emine Dibek MISIRLIOĞLU, Ülker KOCAK

Remembering the Importance of an Old Friend: History Taking in Preoperative Evaluation of Healthy Children: A Single Center Experience

Amaç: Bu çalışma, öykü ve fizik muayenesinde patolojik özelliği olmayan minör cerrahi uygulanan çocuklarda preoperatif değerlendirme sırasında istenen değerlendirmeye katkısını ortaya koymak amacıyla planlanmıştır. Hastalar ve Yöntem: Elektif koşullarda cerrahi işlem uygulanmış, yaşları 0 ile 16 yaş arasında değişen toplam 1322 çocuğun kayıtları retrospektif incelendi. Bulgular: Çocukların 1246'sının (% 94.3) fizik muayene ve laboratuvar bulguları normaldi. Fizik muayene ve laboratuvar tetkiklerinde patoloji saptanan 76 çocuğun pediatri polikliniğine danışıldığı görüldü. Bu çocuklar değerlendirildiğinde 42 çocuğun 23'ü (% 30.2) üst solunum yolu enfeksiyonu, beşi (% 6.5) demir eksikliği anemisi, dördü ( 5.3) masum üfürüm, ikisi (% 2.6) talasemi taşıyıcılığı, ikisi (% 2.6) alt solunum yolu enfeksiyonu, biri (%1.3) idrar yolu enfeksiyonu, biri (%1.3) kabakulak, biri (%1.3) akut gastroenterit, biri (%1.3) minimal aort ve triküspit kapak yetmezliği, biri (%1.3) minimal aort stenozu, biri (%1.3) atrial septal defekt tanısı aldı. Enfeksiyonu olan hastaların ameliyatı enfeksiyon tedavi süresince ertelendi. 25 çocukta ikinci kez tekrarlanan preoperatif testler normal bulundu, ancak 9 öykü ve fizik inceleme bulgularının enfeksiyonla ilişkisi saptanan 9 hastada lökosit sayısı artmış veya azalmış olarak devam etti. Sonuç: Öykü ve fizik muayenesinde patolojik özelliği olmayan grade 1-2 cerrahi grubu çocuklarda rutin uygulanan laboratuvar testlerinin preoperatif değerlendirmeye çok az katkısı bulunmaktadır.

Sağlıklı Çocuklarda Rutin Preoperatif Laboratuvar Testlerinin Kullanımı ve Preoperatif Değerlendirmede Öykünün Önemi: Tek Merkez Deneyimi

Objective: To investigate the consequences of routine laboratory tests that lead to surgical delay or high cost in patients with a normal medical history and physical examination who undergo minor surgical interventions. Patients and Method: Files of 1,322 patients aged between 0-16 years that had undergone elective surgical intervention within six years were reviewed. Results: Of the 1,322 patients, 1,246 (94.3%) had normal physical examination and laboratory findings. Seventy-six children who had abnormalities in laboratory findings and physical examination were referred to pediatrics. Of the 76 pediatric referees, 42 (55.3%) were reevaluated and were diagnosed with upper respiratory tract infection (n=23; 30.2%), iron deficiency anemia (n=5; 6.5%), innocent murmur (n=4; 5.3%), thalassemia minor (n=2; 2.6%), lower respiratory tract infection (n=2; 2.6%), urinary tract infection (n=1; 1.3%), mumps (n=1; 1.3%), acute gastroenteritis (n=1; 1.3%), minimal aortic and tricuspid valve insufficiency (n=1; 1.3%), minimal aortic stenosis (n=1; 1.3%), atrial septal defect (n=1; 1.3%). Surgical interventions were delayed until the recovery of the infectious diseases. In 25 of the patients, repeated tests showed normal ranges after the second test; however nine (n=9) of the patients showed increased or decreased numbers of white blood cell counts and whose medical history and physical examination revealed signs and symptoms related to infection. Conclusion: Routine laboratory tests contribute little to preoperative evaluation of children with normal history and physical examination undergoing low grade surgery.

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