Presentation and management of epistaxis at a tertiary care center: A retrospective review.
This retrospective review of 521 pediatric emergency-department epistaxis presentations found that cancer history, otolaryngology consultation, and bleeding severity were independently associated with longer length of stay, while other clinical factors predicted severity or recurrence.
Open original publication →What the AI sees
This retrospective review of 521 pediatric emergency-department epistaxis presentations found that cancer history, otolaryngology consultation, and bleeding severity were independently associated with longer length of stay, while other clinical factors predicted severity or recurrence.
Research significance
The evidence supports cancer history as a predictor of longer emergency-department stay, but not as a predictor of bleeding severity, recurrence, or response to a particular intervention; it may therefore justify prospective evaluation of oncology-informed triage pathways, although any improvement in care or outcomes remains inferential.
Source abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.