Management of paediatric post-tonsillectomy bleeds - does everyone need observation?

Area of Science:

• Otolaryngology
• Pediatric Surgery

Background:

• Management of non-active post-tonsillectomy bleeds (PTB) is debated.
• Current practice often involves observation due to bleeding risk.
• Identifying low-risk patients for early discharge is crucial.

Purpose of the Study:

• To review post-tonsillectomy bleed admissions.
• To assess the risk of rebleeding during observation.
• To identify criteria for safe early discharge without observation.

Main Methods:

• Retrospective chart review of pediatric patients with PTB.
• Data collected from Perth Children's Hospital (Feb 2018 - Feb 2022).
• Exclusion of primary PTB, blood dyscrasias, and patients >16 years.

Main Results:

• 826 secondary PTB (sPTB) presentations reviewed; 752 observed.
• 2.9% of observed patients rebled; 0.53% with no clot at presentation rebled.
• Patients with clot at presentation had a 3.1% rebleed rate.

Conclusions:

• Secondary PTB patients have a low rebleeding risk during observation.
• Normal oropharyngeal exam indicates very low rebleed risk, supporting early discharge.
• Oropharyngeal clot presence allows safe observation with low rebleed risk.