Presentation and management of epistaxis at a tertiary care center: A retrospective review

To characterize the clinical presentation, management, and outcomes of pediatric epistaxis in a tertiary care center and to identify factors associated with emergency department (ED) length of stay, otolaryngology consultation, bleeding severity, and recurrence.

A retrospective chart review was performed for patients younger than 18 years presenting to the ED with epistaxis between July 2009 and December 2023. Data collected included demographic characteristics, clinical features, comorbidities, environmental factors, investigations, management approaches, and outcomes including resolution and recurrence. Multivariable regression analyses were conducted to determine independent predictors of consultation, length of stay, severity, and recurrence.

A total of 521 patients were included (mean age 8.76 ± 4.97 years; 62.4% male). The majority of cases (61.4%) were idiopathic. Among cases that were not idiopathic (38.6%), trauma was the most common identifiable cause (16.5%). Otolaryngology consultation was required in 51.3% of visits. Median ED length of stay was 64 min and was independently associated with cancer history, otolaryngology consultation, and increased bleeding severity (all p < 0.01). Greater bleeding severity was independently associated with weekend/holiday presentation, recent intranasal surgery, and coagulopathy (all p < 0.05). Recurrence occurred in 9.6% of patients and was independently predicted by male sex and medication use at presentation.

Though epistaxis was predominantly anterior and self-limited, several patients required specialist consultation. Risk-stratified management approaches may improve care delivery and resource allocation, particularly in resource-limited settings, though this warrants further investigation.