ElAlfy Mohsen Saleh, Tantawy Azaa Abdel Gawad, Eldin Badr Eldin Mostafa Badr, Mekawy Mohamed Amin, Mohammad Yasmeen Abd elAziz, Ebeid Fatma Soliman Elsayed
Department of Pediatrics, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Department of Ear, Nose and Throat Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Int Arch Otorhinolaryngol. 2021 Jun 3;26(2):e183-e190. doi: 10.1055/s-0041-1726040. eCollection 2022 Apr.
Epistaxis is a common presentation among children. 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. 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. 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. 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.
鼻出血是儿童中的常见症状。为了研究一种简单评估工具对鼻出血患者的适用性，该工具可用于对可能有出血倾向、可能需要进一步评估的患者进行亚组划分。招募了因不明原因鼻出血到三级门诊就诊的儿童。他们接受了全面的临床评估，并回答了儿童出血问卷和鼻出血严重程度评分。所有患者均进行了全血细胞计数以及凝血功能检查，并根据需要进行了确诊性诊断测试。在一年中到门诊就诊的30043名患者中，有100名儿童患有鼻出血，估计年发病率为1/300。共有84%的患者年龄小于12岁，其中近一半年龄小于6岁。76例患者有复发性鼻出血，12例有全身性合并症。一年中炎热月份鼻出血患者的比例明显更高。共有90%的患者表现为前部出血，大多数仅通过鼻腔压迫治疗。43例患者仅表现为鼻出血；其中37例被诊断为特发性鼻出血，6例有局部原因。57例患者有其他出血表现，其中47例有明确的出血性疾病，另外10例有未确诊的出血倾向。有其他出血表现的患者鼻出血家族史阳性、由初级保健医生转诊、血小板计数极低且季节性变化较小的频率更高。出血评分≥2在怀疑存在潜在全身性病理作为鼻出血原因方面具有显著价值。儿童出血问卷是一种有用且简单的工具，可用于识别需要进一步诊断测试以检测任何潜在出血倾向的儿科患者。
