Risk Factors and Management Outcomes in Pediatric Epistaxis at an Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Otolaryngology
• Hematology

Background:

• Most pediatric epistaxis (nosebleeds) cases are mild and resolve spontaneously.
• A significant minority of children present to the emergency department (ED) with moderate to severe epistaxis requiring intervention.

Purpose of the Study:

• To identify risk factors associated with moderate and severe pediatric epistaxis in the ED.
• To explore the management outcomes for different severities of epistaxis.

Main Methods:

• Retrospective review of 858 pediatric patients (<22 years) with epistaxis presenting to the ED from 2013-2022.
• Classification of epistaxis severity: mild, moderate (requiring cautery/packing), and severe (requiring factor replacement, transfusion, admission, or surgery).
• Univariable and multinomial regression analyses to identify risk factors and outcomes based on epistaxis severity.

Main Results:

• Moderate epistaxis (5%) was associated with older age, recent prior ED visits, and antiplatelet use.
• Severe epistaxis (8%) was linked to bleeding disorders, recent nasal procedures, and anticoagulation use.
• Prolonged bleeding (>30 min) before arrival was a risk factor for both moderate and severe cases. Severe cases frequently required admission (77%), transfusions (42%), and occasionally surgery (7%).

Conclusions:

• Epistaxis severity in children is associated with specific identifiable risk factors.
• While most pediatric nosebleeds are mild, identifying risk factors is crucial for managing moderate to severe cases presenting to the ED.