Trends in Laboratory Evaluation and Risk Factors for Transfusion Therapy in Pediatric Epistaxis

This study examines practices in laboratory evaluation and transfusion therapy for pediatric epistaxis in the emergency department (ED).

We conducted a single-center retrospective study of children (<21 years) evaluated in the ED for epistaxis from 2013 to 2023. Extracted data included demographics, medical history, laboratory evaluation, and treatments. Laboratory testing included complete blood count (CBC) and coagulation tests. We performed descriptive analyses to describe factors associated with laboratory testing and transfusion therapy.

Of 944 children (median age 8.8 years; interquartile range, 4.2-14.2 years), 296 (31.4%) underwent laboratory testing. Among recipients, 119 (40.2%) received a CBC alone and 174 (58.7%) received both CBC and coagulation tests. Factors associated with laboratory testing included older age, White race, use of antiplatelet medications, recent nasal procedures, and sinonasal vascular malformations. Transfusions were administered to 46 children (4.9%), including blood (n = 9, 19.6%), platelets (n = 10, 21.7%), factor replacement (n = 11, 23.9%), and multiple products (n = 16, 34.8%). Factors associated with undergoing both laboratory evaluation and transfusion included prolonged epistaxis, active bleeding at presentation, recurrent epistaxis within 24 hours, a known bleeding disorder, an existing oncological condition, anticoagulant use, a prior history of epistaxis, and nasal interventions performed in the ED.

Laboratory evaluation and transfusions are infrequently performed in pediatric epistaxis. However, prolonged or recurrent bleeding, underlying bleeding disorders, existing oncological conditions, anticoagulant use, and nasal interventions performed to control bleeding are associated with an increased likelihood of laboratory testing and transfusion therapy in the ED.