Do post-tonsillectomy patients who report bleeding require observation if no bleeding is present on exam?

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Emergency Medicine

Background:

• Post-tonsillectomy hemorrhage affects 3-10% of patients.
• Patients presenting to the Emergency Department (ED) with hemorrhage may have active bleeding, a clot, or a normal exam.
• The need for inpatient observation in patients with a normal post-operative exam after hemorrhage is unclear.

Purpose of the Study:

• To determine if patients with post-tonsillectomy hemorrhage and a normal post-operative exam require inpatient observation.
• To evaluate the rate of subsequent bleeding in this patient cohort.

Main Methods:

• Retrospective series (2010-2014) at a tertiary pediatric hospital.
• Evaluated patients presenting to the ED with post-tonsillectomy hemorrhage and a normal post-operative exam.
• Assessed for subsequent bleeding requiring cauterization and analyzed demographic/clinical data.

Main Results:

• Of 337 visits with a history of bleeding and a normal exam, 38 (11%) subsequently bled requiring cauterization.
• The majority of re-bleeding (84%) occurred within 24 hours of ED admission.
• No specific demographic or clinical variables predicted increased risk during observation.

Conclusions:

• Eleven percent of patients with post-tonsillectomy hemorrhage and a normal ED exam subsequently bled, typically within 24 hours.
• History of bleeding at home was the only significant factor for re-bleeding.
• Recommend 24-hour in-hospital observation for patients with a history of bleeding but a normal exam.