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Post-tonsillectomy hemorrhage and pediatric emergency care
Jeffrey Peterson1, Joseph D Losek
1Children's Hospitals and Clinics--St. Paul, St. Paul, MN 55102, USA.
Insights
Secondary post-tonsillectomy hemorrhage in children is often manageable. Surgical intervention is recommended for bleeding signs, while observation is suitable for those without bleeding signs.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Surgical Outcomes
Background:
- Secondary post-tonsillectomy hemorrhage is a significant concern in pediatric care.
- Understanding risk factors and optimal management strategies is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the clinical presentation and management of secondary post-tonsillectomy hemorrhage in children.
- To evaluate the effectiveness of surgical versus observational approaches based on bleeding signs.
Main Methods:
- Retrospective review of 90 pediatric patients with secondary post-tonsillectomy hemorrhage over two years.
- Data collection included patient demographics, time to presentation, clinical signs, and treatment outcomes.
- Analysis of repeat bleeding episodes based on initial management strategy and presence of bleeding signs.
Main Results:
- The average age of affected children was 8.5 years, with a mean presentation time of 7.3 days post-tonsillectomy.
- Among children with bleeding signs, 90% underwent surgical management, while 10% were observed.
- Repeat bleeding occurred in 6% of surgically treated patients versus 43% of observed patients with bleeding signs. No repeat bleeding was observed in patients without initial bleeding signs.
Conclusions:
- Active hemorrhage and cardiovascular compromise are infrequent in pediatric secondary post-tonsillectomy hemorrhage.
- Surgical management is recommended for children presenting with signs of bleeding.
- Observation appears appropriate for children without observable signs of bleeding in the tonsillar fossa.
Abstract:
A cross-sectional, retrospective review of consecutive patients who presented to 1 of 2 pediatric emergency departments with post-tonsillectomy hemorrhage was undertaken. The study population included children who had secondary hemorrhage (bleeding at greater than 24 hours after tonsillectomy). Over a period of 2 years, 90 children received emergency care for secondary post-tonsillectomy hemorrhage. The average age was 8.5 years and there were 40 (44%) males. The average time from tonsillectomy to emergency department (ED) presentation was 7.3 days. One patient was hypotensive, and 7 had hemoglobins <10 mg/dL. Signs of bleeding on examination of the tonsillar fossa were active (4), oozing (18), clots (48), and none (14). Of the 70 children with signs of bleeding, 63 (90%) were treated surgically and 7 (10%) were observed. Four (6%) of the 63 children who had signs of bleeding and were managed surgically and 3 (43%) of the 7 children who had signs of bleeding and were managed by observation had repeat episodes of bleeding. Of the 14 patients with no signs of bleeding, all were observed and none had repeat episodes of bleeding. Signs of bleeding were not documented in 6 patients. Active hemorrhage and cardiovascular compromise were uncommon in this study population. Surgical management is recommended for children who have signs of bleeding, while observation appears to be appropriate for children who have no signs of bleeding.
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