Shay Sophie, Shapiro Nina L, Bhattacharyya Neil
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 200 Medical Plaza, Suite 550, Los Angeles, CA 90095, USA.
Department of Otology & Laryngology, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA.
Int J Pediatr Otorhinolaryngol. 2017 Dec;103:121-124. doi: 10.1016/j.ijporl.2017.10.026. Epub 2017 Oct 17.
Investigate the epidemiological characteristics of pediatric epistaxis in the emergency department setting.
Cross-sectional study using national databases.
Children (age <18 years) presenting with a diagnosis of epistaxis were extracted from the State Emergency Department Databases for New York, Florida, Iowa, and California for the calendar year 2010. Associated diagnoses, procedures, encounter characteristics, and demographic data were examined.
There were 18,745 cases of pediatric epistaxis (mean age 7.54 years, 57.4% male). Overall, 6.9% of patients underwent procedures to control epistaxis, of which 93.5% had simple anterior epistaxis control. The distribution of pediatric epistaxis was highest in spring and summer months (p < 0.001). Children from the lowest income quartile comprised a higher proportion of epistaxis presentations (38.8%, p < 0.001), yet were least likely to have an epistaxis control procedure performed (p < 0.001). Most patients had either Medicaid (43.8%) or private insurance (41.3%). Patients with Medicaid and those without healthcare coverage were least likely to undergo an epistaxis control procedure (p < 0.001). White children were more likely to undergo an epistaxis control procedure compared to those of minority backgrounds (p < 0.001).
Most emergency department presentations of pediatric epistaxis are uninvolved cases that do not require procedural intervention. The overrepresentation of low socioeconomic status patients may suggest an overutilization of emergency services for minor cases of epistaxis, and perhaps a lack of access to primary care providers. This is the first study to evaluate racial and socioeconomic factors in relationship to pediatric epistaxis. Further investigation is needed to better elucidate these potential disparities.
调查急诊科小儿鼻出血的流行病学特征。
使用国家数据库的横断面研究。
从纽约州、佛罗里达州、爱荷华州和加利福尼亚州的国家急诊科数据库中提取2010历年诊断为鼻出血的儿童（年龄<18岁）。检查相关诊断、程序、就诊特征和人口统计学数据。
共有18745例小儿鼻出血病例（平均年龄7.54岁，57.4%为男性）。总体而言，6.9%的患者接受了控制鼻出血的程序，其中93.5%进行了简单的前位鼻出血控制。小儿鼻出血的分布在春季和夏季月份最高（p<0.001）。收入最低四分位数的儿童鼻出血就诊比例较高（38.8%，p<0.001），但进行鼻出血控制程序的可能性最小（p<0.001）。大多数患者有医疗补助（43.8%）或私人保险（41.3%）。有医疗补助的患者和没有医疗保险的患者进行鼻出血控制程序的可能性最小（p<0.001）。与少数族裔背景的儿童相比，白人儿童更有可能接受鼻出血控制程序（p<0.001）。
大多数急诊科小儿鼻出血病例为无需程序干预的非复杂病例。社会经济地位低的患者比例过高可能表明在轻微鼻出血病例中过度使用了急诊服务，也可能是缺乏获得初级保健提供者的途径。这是第一项评估与小儿鼻出血相关的种族和社会经济因素的研究。需要进一步调查以更好地阐明这些潜在差异。
