Recurrent epistaxis in children

The Impact of Recurrent Epistaxis on the Quality of Life of Children and the Functioning of Their Families

Introduction Epistaxis, or nosebleeds, is a common pediatric emergency, impacting their quality of life (QoL). Existing research on epistaxis has predominantly focused on clinical aspects, overlooking its broader impact on the quality of life of affected children and the functioning of their families. This study seeks to fill that gap by assessing the impact of recurrent epistaxis on children's QoL, family dynamics, and parental stress in Saudi Arabia's Eastern region. Methods A survey was conducted involving 168 parents of children with recurrent epistaxis, using the Pediatric Quality of Life InventoryTM (PedsQL 4.0TM) Short Form (SF) for QoL assessment across different age groups, the PedsQL 2.0 Family Impact Module to evaluate the effect of the child's health on family dynamics, and a custom questionnaire for gathering sociodemographic and health-related information. Better QoL and family functioning were indicated by higher scores. Results Recurrent epistaxis was more frequent (>4 times per year) in 58.9% of cases, with unknown causes in 72%. A total of 116 (69%) of the children never needed medical intervention for epistaxis and 52 (31%) visited ER 1-2 times. The lowest scores for both children and parents were in the emotional functioning domains (77.9 and 78.2, respectively). In the study, both parents and children who had no history of ER visits exhibited significantly higher quality of life (QoL) scores compared to those who did, with parents reporting 83.7% versus 77.2% (P=.022), and children showing 84.6% versus 79.9% (P=.049), respectively. Parents of older children, ages 13-18 years, reported a higher Quality of Life (QoL) at 83.9%, compared to those with younger children, ages 2-4 years, who reported a QoL of 57.3% (P=.003). Conclusion The overall QoL scores of families of children with recurrent epistaxis were relatively high, indicating a variable and limited general impact. Significantly higher QoL was observed in families of older children and those without ER visits.

Prospective review of 188 cases of epistaxis presenting to the emergency department: Etiology and outcome

Background

Due to a myriad of risk factors, epistaxis is a very frequent presentation to the emergency room (ER). This study aims to ascertain the prevalence of epistaxis in our population, risk factors, effectiveness of ER treatment, complications, and ER outcome.

Materials and Methods

This was a prospective observational study performed in the ER of a referral tertiary care center in south India. Data were categorized, coded, and analyzed to determine the objective of the study.

Results

During the study's six-month duration, 188 (0.6%) patients presented with epistaxis. The mean age was 42.9 (SD: 16.49) years, with a male preponderance of 143 (76.1%). A majority of these patients (n: 156; 82.9%) were triaged as priority II, with hypertension (n: 53, 28.2%) as the commonest comorbidities. Trauma-related epistaxis (n: 107, 56.9%) was the most frequent cause. Anterior nasal packing was carried out for 85 (45.2%) patients, posterior nasal packing was carried out for one (0.5%) patient, and bleeding had spontaneously resolved in the majority (n: 102; 54.3%) patients. Seven (3.7%; p-value: 0.001) patients had recurrent epistaxis, and of those, three (1.6%) required urgent resuscitation with crystalloid fluid and blood products. Two of these patients had bleeding dyscrasias, four had history of trauma, and one patient presented with uncontrolled hypertension. Two (1.1%) patients came back to us with recurrent bleeding within 12 h of discharge. Majority (69.2%; 130) were discharged stable, (23.9%; 45) were admitted for observation and (6.9%; 13) were discharged against medical advice. There was no mortality among these study populations.

Conclusion

Middle-young, aged males most commonly presented with epistaxis. Most of them were secondary to trauma. Anterior nasal bleeding was the most common source and hemostasis could be obtained by anterior nasal packing. Majority could be discharged stable from the ER. However, this cohort had seen patients in life-threatening conditions, so the severity cannot be overlooked.

Analysis of Multimorbidity of Moderate to Severe Allergic Rhinitis in Children: A Real-World Study

INTRODUCTION

Allergic rhinitis (AR) in children is associated with various comorbidities, posing challenges for treatment and management. There have been few investigations of these multimorbidities in Chinese children with AR. Here, we investigated the prevalence of multimorbidities in children with moderate to severe AR and analyzed the influencing factors using real-world data.

METHODS

In total, 600 children who visited the outpatient clinic of our hospital and were diagnosed with moderate-severe AR were prospectively enrolled. All children underwent allergen detection and electronic nasopharyngoscopy. Parents or guardians completed a questionnaire that included age, sex, mode of delivery, feeding pattern, and familial history of allergy. The multimorbidities investigated included atopic dermatitis (AD), asthma, allergic conjunctivitis (AC), chronic rhinosinusitis (CRS), adenoid hypertrophy (AH), tonsil hypertrophy (TH), recurrent epistaxis, and recurrent respiratory tract infections (RRTIs).

RESULTS

The AR multimorbidities reported in children were as follows: recurrent epistaxis (46.5%), AC (46.3%), AD (40.7%), asthma (22.5%), RRIs (21.3%), CRS (20.5%), AH (19.7%), and TH (12.5%). In univariate logistic regression analysis, age (<6 years), birth mode, familial history of allergy, and single dust mite allergy were associated with AR multimorbidity (p < 0.05). Multivariate logistic regression revealed that a familial history of allergy was an independent risk factor for AC (odds ratio [OR] = 1.539, 95% confidence interval [CI]: 1.104-2.145) and AH (OR = 1.506, 95% CI: 1.000-2.267) (p < 0.05). Age (<6 years) was independently associated with the risk of AD (OR = 1.405, 95% CI: 1.003-1.969) and RRTIs (OR = 1.869, 95% CI: 1.250-2.793) (p < 0.05), cesarean section with AR and CRS risk (OR = 1.678, 95% CI: 1.100-2.561), and single dust mite allergy with asthma (OR = 1.590, 95% CI: 1.040-2.432) and CRS (OR = 1.600, 95% CI: 1.018-2.515) risk (p < 0.05). Further, non-dust mite allergy was independently associated with AR and CRS (OR = 2.056, 95% CI: 1.084-3.899).

CONCLUSION

AR was found to be accompanied by different comorbidities, including both allergic and non-allergic comorbidities, complicating disease treatment. These findings demonstrated that age (<6 years), familial history of allergy, types of allergens, and cesarean section were risk factors for different multimorbidities associated with AR.

Low-intensity diode laser combined with nasal glucocorticoids in the treatment of recurrent epistaxis in children: a randomized controlled trail

BACKGROUND

A painless and effective treatment of childhood epistaxis is needed.

OBJECTIVE

To observe the effectiveness of low-intensity diode (Lid) laser in treating epistaxis complicated with allergic rhinitis in children.

METHODS

Our study is a prospective, randomized, controlled, registry trial (NO. 202001201) involving 44 recurrent epistaxis children (<14 years old) with or without Allergic Rhinitis (AR) in our hospital. They were divided randomly into the Laser and Control groups. The Laser group was treated with Lid laser (wavelength 635 nm, power 15mW) for 10 min after nasal mucosa was moistened with normal saline (NS). The Control group moistened their nasal cavities with NS only. Children in two groups complicated with AR were given nasal glucocorticoids for 2 weeks. The effectiveness of Lid laser in treating epistaxis and AR were compared between the two groups after treatment.

RESULTS

After treatment, the effective rate of the Laser group in epistaxis (23/24, 95.8%) was higher than the Control group (16/20, 80%) (p < .05). The VAS scores of the children complicated with AR in the two groups both improved after treatment, however, the variation of VAS score (3.02 ± 1.50) in the Laser group was greater than the Control group (1.83 ± 1.56) (p < .05).

CONCLUSION

As a safe and efficient method, Lid laser treatment can effectively alleviate epistaxis and inhibit symptoms of AR in children.

Epistaxis duration predicts bleeding in immune thrombocytopenia: a cohort study

OBJECTIVE

To test for an association between duration of epistaxis and clinically relevant bleeding in the following 12 months in children with immune thrombocytopenia (ITP).

DESIGN

Prospective cohort study.

SETTING

The national UK Paediatric ITP registry, a multicentre prospective clinical registry of new cases of ITP between 2006 and February 2020.

PATIENTS

All children aged between 2 months and 16 years in participating UK centres.

EXPOSURE

Epistaxis at presentation defined as none, <10 min, 10-30 min and >30 min.

MAIN OUTCOME MEASURES

Incident severe bleeds, combined moderate and severe bleeds and drop in haemoglobin (Hb) by ≥20 g/L.

RESULTS

The sample included 1793 patients, of which 334 had epistaxis <10 min, 88 lasting 10-30 min and 97 >30 min. In the 12 months following presentation, 19 had a severe bleed, 140 had a moderate bleed and 54 had a drop in Hb ≥2 g/dL. Epistaxis >30 min duration was associated with increased odds of severe bleeds (OR 1.43-15.67), moderate or severe bleeding (OR 1.33-4.2) and drop in Hb (OR 1.23-6.91). Shorter duration epistaxis was not associated with increased odds of any outcome. A trend for increased odds with longer duration epistaxis was significant for all outcomes.

CONCLUSIONS

The longer the duration of epistaxis at presentation with ITP, the higher the risk of a clinically significant bleeding event in the 12 months following. This should inform clinical severity ratings and treatment decisions.