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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2022; 26(02): e183-e190
DOI: 10.1055/s-0041-1726040
Original Article

Epistaxis in a Pediatric Outpatient Clinic: Could It be an Alarming Sign?

Mohsen Saleh ElAlfy
1   Department of Pediatrics, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
,
Azaa Abdel Gawad Tantawy
1   Department of Pediatrics, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
,
Badr Eldin Mostafa Badr Eldin
2   Department of Ear, Nose and Throat Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
,
Mohamed Amin Mekawy
3   Department of Clinical Pathology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
,
Yasmeen Abd elAziz Mohammad
1   Department of Pediatrics, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
,
Fatma Soliman Elsayed Ebeid 
1   Department of Pediatrics, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Abstract

Introduction Epistaxis is a common presentation among children.

Objective To investigate the suitability of a simple tool of assessment for patients with epistaxis that could guide in subgrouping those with possible bleeding tendencies who may need further assessment.

Methods Children who presented to a tertiary outpatient clinic with epistaxis of an unknown cause were recruited. They underwent thorough clinical assessment and answered the pediatric bleeding questionnaire and the epistaxis severity score. All patients underwent complete blood count as well as coagulation profile, and confirmatory diagnostic tests were performed as needed.

Results Among the 30,043 patients who presented to the outpatient clinic over a year, 100 children had epistaxis, with an estimated annual frequency of 1 in 300. A total of 84% of the patients were younger than 12, and nearly half of these were younger than 6 years. Seventy-six patients had recurrent epistaxis, and 12 had systemic comorbidities. A significant higher percentage of patients presented with epistaxis in the hot months of the year. A total of 90% of the patients presented anterior bleeding, and the majority were treated with nasal compression only. Forty-three patients presented with epistaxis only; 37 of them were diagnosed as idiopathic epistaxis, and 6 had local causes. Fifty-seven patients presented with other bleeding manifestations, 47 of whom had a definite bleeding disorder and the other 10 had undiagnosed bleeding tendency. Those with other bleeding manifestations showed a higher frequency of positive family history of epistaxis; of being referred from a primary care physician; of having alarming low platelet count, and of presenting less seasonal variability. A bleeding score ≥ 2 showed significant value in suspecting an underlying systemic pathology as a cause of epistaxis.

Conclusion The pediatric bleeding questionnaire is a useful and simple tool in the identification of pediatric patients who need further diagnostic testing to detect any underlying bleeding tendency.

Keywords

epistaxis - children - outpatient clinic - bleeding disorder

Note

The present manuscript has not been submitted elsewhere nor previously published.


The corresponding author, on behalf of all authors, hereby states that all authors have contributed to the manuscript in significant ways, reviewed and agreed upon the manuscript content.




Publication History

Received: 26 February 2020

Accepted: 24 November 2020

Article published online:
03 June 2021

© 2021. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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