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Severity and Features of Epistaxis in Children with a Mucocutaneous Bleeding Disorder
Eva Stokhuijzen1, Catherine I Segbefia2, Tina T Biss3
1Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Standardized bleeding questionnaires effectively assess epistaxis severity in children with bleeding disorders. These tools help differentiate patients with mucocutaneous bleeding disorders from healthy children.
Area of Science:
- Pediatric Hematology
- Clinical Diagnostics
Background:
- Epistaxis is a common symptom in children.
- Mucocutaneous bleeding disorders can present with significant epistaxis.
- Standardized assessment tools are needed to quantify epistaxis severity.
Purpose of the Study:
- To compare epistaxis severity and patterns in children with mucocutaneous bleeding disorders versus controls.
- To evaluate the utility of standardized bleeding questionnaires in this comparison.
Main Methods:
- Retrospective review of the epistaxis sections of the Pediatric Bleeding Questionnaire (PBQ).
- Inclusion of pediatric patients with von Willebrand disease or platelet function disorders and healthy controls.
- Recording of epistaxis features and application of the Katsanis epistaxis scoring system.
Main Results:
- Patients with bleeding disorders had significantly higher PBQ epistaxis scores (median 2) than controls (median 0).
- Features of epistaxis, except spontaneous onset, were more common in patients.
- 50% of patients had severe epistaxis by Katsanis scoring, with 91% having clinically significant PBQ scores.
Conclusions:
- Standardized bleeding questionnaires are valuable for assessing epistaxis.
- These questionnaires aid in distinguishing children with mucocutaneous bleeding disorders.
- The PBQ can effectively identify clinically significant epistaxis in pediatric patients.
Objective:
To use standardized bleeding questionnaires to compare the severity and patterns of epistaxis in children with a mucocutaneous bleeding disorder and control children.
Study Design:
The epistaxis sections of the Pediatric Bleeding Questionnaire (PBQ) administered to pediatric patients with von Willebrand disease or a platelet function disorder and healthy control children were reviewed. Scores and features of epistaxis (frequency, duration, onset, site, seasonal correlation, and need for medical/surgical intervention) were recorded. A PBQ epistaxis score ≥2 was defined as clinically significant. The Katsanis epistaxis scoring system was administered to eligible patients, ie, with ≥5 episodes of epistaxis per year.
Results:
PBQ epistaxis scores were obtained for 66 patients, median age 12 years (range 0.6-18.3 years), and 56 control children. The median PBQ epistaxis score in patients was 2 vs 0 in control children (P <.0001). All of the features of epistaxis, except spontaneous onset, occurred in a significantly greater proportion of patients than control children with epistaxis. A total of 50% of the patients were graded as having severe epistaxis by the Katsanis epistaxis scoring system, and 30 of these (91%) had a clinically significant PBQ epistaxis score.
Conclusion:
Standardized bleeding questionnaires are useful in the assessment of epistaxis severity and pattern and may help to distinguish children with and without a mucocutaneous bleeding disorder.
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