Pediatric Post-Tonsillectomy Hemorrhage Management: A Cross-Sectional Otolaryngology and Emergency Medicine Survey

To evaluate current trends and management strategies for post-tonsillectomy hemorrhage (PTH) among otolaryngology (ENT) and emergency medicine (EM) physicians.

A survey was developed by a panel of pediatric ENT, critical care, and EM physicians. Questions assessed therapies and definitions of PTH. Survey distribution was to members of the American Society of Pediatric Otolaryngology (ASPO) and a common pediatric emergency medicine listserv (PED-EM-L).

Overall response rate was low at 6.5% (ENT: 110, EM: 134, Total: 244). Compared with EM respondents, ENT providers were more likely to have over 10 years of experience (60% vs. 46%; p = 0.023). ENT providers were less likely to include "return to the operating room" as a defining feature of post-tonsillectomy hemorrhage (59% vs. 81%; p < 0.001) and less likely to estimate that ≥ 10% of patients require reoperation for bleeding (17% vs. 71%; p < 0.001). PTH non-operative managements selected as most likely to be used in the past 6 months were observation (ENT: 44% vs. EM: 55%), nebulized tranexamic acid (TXA) (ENT: 29% vs. EM: 66%), intravenous TXA (ENT: 16% vs. EM: 31%), direct pressure (ENT: 4% vs. EM: 10%), and topical agents such as salt water gargle (ENT: 7% vs. EM: 19%). After adjusting for confounders (gender, PTH definition, percent returning to operating room, years in practice, practice setting), ENT providers were less likely to use nebulized TXA compared to EM respondents (p < 0.001).

Significant variability exists between ENT and EM providers in the definition and use of TXA for PTH. Larger, well-designed studies and targeted educational initiatives are needed to validate and standardize non-operative strategies for PTH management.