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Pediatric epistaxis
John F Damrose1, John Maddalozzo
1Department of Otolaryngology/Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois 60614, USA.
Insights
Pediatric epistaxis (nosebleeds) evaluation should screen for anemia and coagulopathy. Routine sinus CT scans are unnecessary, and most nosebleeds resolve with nasal rehydration, though rhinosinusitis may be a factor.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Medical Diagnostics
Background:
- Epistaxis is a common pediatric concern.
- Optimal evaluation and treatment strategies lack consensus among otolaryngologists.
Purpose of the Study:
- To evaluate an outpatient approach for pediatric epistaxis.
- To identify key diagnostic and treatment components for pediatric nosebleeds.
Main Methods:
- Retrospective chart review of 90 pediatric patients with epistaxis.
- Analysis of laboratory findings (anemia, coagulopathy) and imaging (CT scans).
Main Results:
- Anemia detected in 22% of patients; coagulopathy in 7.8%.
- Sinus CT scans (nearly 90% of patients) revealed no masses but common opacification suggesting sinusitis.
- Most cases resolved with topical nasal emollients.
Conclusions:
- Outpatient epistaxis evaluation should include anemia and coagulopathy screening.
- Routine sinus CT imaging is not recommended for pediatric epistaxis.
- Nasal mucosal rehydration is effective; consider rhinosinusitis as a contributing factor.
Objectives/Hypothesis:
Otolaryngologists are frequently consulted for the evaluation and treatment of pediatric epistaxis. There is a lack of consensus as to the optimal approach to this problem. This study evaluated an approach used to evaluate and treat patients referred on an outpatient basis.
Study Design:
Retrospective study.
Methods:
Charts from 90 patients referred for the treatment of epistaxis were reviewed.
Results:
Anemia was identified in 22% of patients. An abnormal coagulation study was identified in 7.8% of patients. Computed tomography (CT) imaging of the sinuses was obtained in nearly 90% of patients and revealed no suspicious masses. Opacification of the sinuses consistent with sinusitis was commonly seen. The majority of cases were resolved by the first follow-up visit with a topical nasal emollient.
Conclusions:
The outpatient evaluation of epistaxis should include a screen for anemia and coagulopathy. Routine CT imaging of the sinuses is unhelpful and is not recommended. The majority of cases are easily treated with rehydration of the nasal mucosa. Consideration should be given to rhinosinusitis as a co-existing factor in patients with epistaxis.
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