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Post tonsillectomy hemorrhage: who needs intervention?

Rajan Arora1, Sonal Saraiya2, Xun Niu3

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Summary
This summary is machine-generated.

Secondary post-tonsillectomy hemorrhage (PTH) in children often leads to admission and intervention. Healthy children under 6 with normal throat exams may be safe for discharge from the pediatric emergency department (PED).

Keywords:
ChildrenDispositionEmergencyHemorrhageInterventionTonsillectomy

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Area of Science:

  • Pediatric Emergency Medicine
  • Otolaryngology
  • Hemorrhagic Complications

Background:

  • Post-tonsillectomy hemorrhage (PTH) is a significant complication in children.
  • Current guidelines are lacking for pediatric emergency department (PED) disposition of secondary PTH cases.

Purpose of the Study:

  • To determine the incidence and clinical features of secondary PTH in children presenting to a PED.
  • To identify factors associated with the need for operative or inpatient intervention for secondary PTH.
  • To inform disposition decisions for children with secondary PTH.

Main Methods:

  • Retrospective chart review of healthy children aged 1-18 years with secondary PTH from 2005-2012.
  • Data collected included demographics, clinical findings, laboratory results, interventions, and disposition.
  • Oropharyngeal examination findings were specifically analyzed.

Main Results:

  • The incidence of secondary PTH was 2.3% among 121 analyzed patients.
  • Most patients did not present with hypotension or severe anemia.
  • A positive oropharyngeal exam (clot, ooze, or active bleeding) was present in 65.3% of patients.
  • 71.9% of patients were admitted, and 61.1% required intervention (medical or surgical).
  • Age ≥6 years and a positive oropharyngeal exam were associated with increased need for intervention.
  • No patient with a normal initial oropharyngeal exam required intervention.
  • Recurrence rates were similar for admitted and discharged patients, with no life-threatening recurrences.

Conclusions:

  • The majority of children with secondary PTH require admission and intervention.
  • Healthy children under 6 years with a normal oropharyngeal exam may be suitable for discharge from the PED.
  • Ensuring reliable return for potential recurrence is crucial for discharged patients.