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Managing recurrent nosebleeds in children: a retrospective review of 718 children attending a nurse-led epistaxis clinic
Published online by Cambridge University Press: 15 January 2024
Abstract
Objective
This review assessed the effectiveness of the nurse-led children's epistaxis clinic in streamlining patient care and avoiding unnecessary general anaesthesia.
Methods
A retrospective case note review was conducted of children attending the nurse-led epistaxis clinic between 2019 and 2021.
Results
A total of 718 children were seen over three years. Twelve (1.7 per cent) had a known coagulopathy. Of the children, 590 (82 per cent) had visible vessels and 29 (4 per cent) had mucosal crusting. Silver nitrate cautery was attempted under topical anaesthesia in 481 children, with 463 (96 per cent) successful cauterisations. Fifteen (3 per cent) were cauterised under general anaesthesia. Of the children, 706 (99 per cent) were prescribed nasal antiseptic preparations; this was the sole treatment for 58 (8 per cent). Blood investigations were requested for eight children (1 per cent) and haematology referral for three (0.4 per cent).
Conclusion
This is the largest published series of children's nosebleeds. Given the short-lived benefit from cautery, it is suggested that general anaesthesia should not be offered routinely. However, improved haematology referral criteria are required to increase underlying diagnosis.
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- Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED
Footnotes
Ivy Drake takes responsibility for the integrity of the content of the paper
Presented at the ENT Scotland Summer Meeting, 11–12 May 2023, Dunblane, Scotland, UK.
References
Ata, N, Bülbül, T, Gökçen, C, Demirkan, A, Çiftçi, MA. Depression and anxiety levels in mothers of children with epistaxis: a controlled study. Acta Otorrinolaringol Esp (Engl Ed) 2019;70:286–9CrossRefGoogle ScholarPubMed
Davies, K, Batra, K, Mehanna, R, Keogh, I. Pediatric epistaxis: epidemiology, management & impact on quality of life. Int J Pediatr Otorhinolaryngol 2014;78:1294–7CrossRefGoogle ScholarPubMed
Downie, L, Kubba, H. Why is there such variation in nasal cautery rates for childhood epistaxis: deprivation or clinician behaviour? National data from Scotland 2000-2019. Rhinology 2022;60:152–4Google ScholarPubMed
Whymark, AD, Crampsey, DP, Fraser, L, Moore, P, Williams, C, Kubba, H. Childhood epistaxis and nasal colonization with Staphylococcus aureus. Otolaryngol Head Neck Surg 2008;138:307–10CrossRefGoogle ScholarPubMed
Saafan, ME, Ibrahim, WS. Role of bacterial biofilms in idiopathic childhood epistaxis. Eur Arch Otorhinolaryngol 2013;270:909–14CrossRefGoogle ScholarPubMed
Kamble, P, Saxena, S, Kumar, S. Nasal bacterial colonization in cases of idiopathic epistaxis in children. Int J Pediatr Otorhinolaryngol 2015;79:1901–4CrossRefGoogle ScholarPubMed
Montague, M-L, Whymark, A, Howatson, A, Kubba, H. The pathology of visible blood vessels on the nasal septum in children with epistaxis. Int J Pediatr Otorhinolaryngol 2011;75:1032–4CrossRefGoogle ScholarPubMed
Kubba, H, MacAndie, C, Botma, M, Robison, J, O'Donnell, M, Robertson, G et al. A prospective, single-blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood. Clin Otolaryngol Allied Sci 2001;26:465–8CrossRefGoogle ScholarPubMed
Calder, N, Kang, S, Fraser, L, Kunanandam, T, Montgomery, J, Kubba, H. A double-blind randomized controlled trial of management of recurrent nosebleeds in children. Otolaryngol Head Neck Surg 2009;140:670–4CrossRefGoogle ScholarPubMed
Sandoval, C, Dong, S, Visintainer, P, Ozkaynak, MF, Jayabose, S. Clinical and laboratory features of 178 children with recurrent epistaxis. J Pediatr Hematol Oncol 2002;24:47–9CrossRefGoogle ScholarPubMed
Makura, ZG, Porter, GC, McCormick, MS. Paediatric epistaxis: Alder Hey experience. J Laryngol Otol 2002;116:903–6CrossRefGoogle ScholarPubMed
Elden, L, Reinders, M, Witmer, C. Predictors of bleeding disorders in children with epistaxis: value of preoperative tests and clinical screening. Int J Pediatr Otorhinolaryngol 2012;76:767–71CrossRefGoogle ScholarPubMed
Limbrick, J, Takwoingi, YM. Bilateral nasal septal chemical cautery: a safe and effective outpatient procedure for control of recurrent epistaxis, our experience in 134 patients. Eur Arch Otorhinolaryngol 2019;276:1845–8CrossRefGoogle ScholarPubMed
Robertson, S, Kubba, H. Long-term effectiveness of antiseptic cream for recurrent epistaxis in childhood: five-year follow up of a randomised, controlled trial. J Laryngol Otol 2008;122:1084–7CrossRefGoogle ScholarPubMed
Public Health Scotland. Reports for Financial Year 2019 to 2020. In: https://publichealthscotland.scot/publications/scottish-health-service-costs/scottish-health-service-costs-costsbook-2020-april-2019-to-march-2020/files-listing-2019-to-2020/ [10 February 2023]Google Scholar
GOSH Hospital Site. Von Willebrand disease. In: https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/von-willebrand-disease/ [19 September 2023]Google Scholar