1131 The Cost of Clotting

Abstract

Introduction: Blood sampling is important in informing the management of critically ill children, but over sampling may cause anaemia, and is an unnecessary expense. We sought to examine the practice of routine coagulation tests (amongst others) in critically ill children.Methods: A prospective audit of all critically ill children admitted to a multidisciplinary regional Paediatric Intensive Care Unit in the Northwest of England. Over 1000 children are admitted each year, with around 85% of these being intubated. We report the first month's results.Results: All children admitted in November 2009 were audited. Of 101 children admitted to PICU, 75 had at least one test of coagulation. 37 of these were admitted with a cardiac diagnosis, 38 had a general diagnosis. In total 4 children died. In all 402 tests were done and 287 (71%) of these tests were abnormal. In response to coagulation abnormalities demonstrated on laboratory testing. FFP, cryoprecipitate or platelets, were given on a total of 80 occasions to 18 children. If children received blood-derived-clotting factors most often this was only on one occasion. This was highly variable. One child who stayed 27 days had 84 tests, all of which we abnormal, receiving factor correction on 40 occasions.Conclusions: Many coagulation tests are performed in critical care. Often, even when the results are abnormal, no action is taken. It is likely that a more judicious approach to sampling will be reflected in lower costs and higher haemoglobin levels or reduced transfusion requirement. Further work is continuing.