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

Andrew Shieh1, James A Cranford1, Angela C Weyand2

  • 1Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.

The Journal of Emergency Medicine
|February 2, 2024
PubMed

Insights

Pediatric epistaxis (nosebleeds) can be severe, requiring emergency department (ED) visits. Older age, prior ED visits, and antiplatelet use predict moderate bleeds, while bleeding disorders and anticoagulation predict severe bleeds.

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.
Abstract

Keywords:
emergency departmentepistaxisnosebleedspediatrics

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