110 - Epistaxis in the Emergency Department: Who Needs Laboratory Evaluation and Receives Transfusions?

Publication Number: 110.4615

Andrew Shieh, CHOC Children's Hospital of Orange County, Orange, CA, United States; James A.. Cranford, University of Michigan Medical School, Ann Arbor, MI, United States; Angela C. Weyand, University of Michigan Medical School, Ann Arbor, MI, United States; Lauren Bohm, University of Michigan Medical School, Ann Arbor, MI, United States; Vivien Phung, CHOC Children's Hospital of Orange County, Orange, CA, United States; Sarah Tomlinson, University of Michigan Medical School, Ann Arbor, MI, United States

Background: Although pediatric epistaxis is common, there is insufficient evidence to suggest which child requires laboratory evaluation with regard to possible need for transfusion. As a result, children are met with a varying degree of medical work up and treatment in the emergency department (ED).

Objective: To compare factors associated with receipt of laboratory evaluation with risk factors associated with the need for transfusion in children with epistaxis.

Design/Methods: We conducted a single-center retrospective study of children ( < 21 years) evaluated in the ED for epistaxis from 2013 to 2023. Extracted data included patient demographics, medical history, symptoms, laboratory results, and treatments. Laboratory evaluation included complete blood cell count (CBC) and coagulation tests. We constructed multivariable logistic regression models to evaluate the association between factors with both the receipt of blood tests and transfusions.

Results: Of 942 children (median age 8.8 years, IQR 4.2-14.2 years; 56% male), 296 (31.4%) received laboratory evaluation. Among recipients, 116 (39.2%) received a CBC, 3 (1.0%) received coagulation tests, and 177 (59.8%) received both tests. In multivariable analyses, age ≥10 years, Hispanic or Latino ethnicity, known bleeding disorders, active bleeding in the ED, and oncological conditions were associated with receipt of a CBC, with oncological conditions having the greatest effect size (adjusted odds ratio, 37.27; 95% CI 4.15-334.60) (Table 1). White or Caucasian race, >1 nosebleeds within 24 hours, and prior history of nosebleeds were associated with receipt of both blood tests. Of 46 (4.9%) children who received transfusions, 9 (19.6%) received blood, 10 (21.7%) received platelets, 11 (23.9%) received factor replacement, and 16 (34.8%) received multiple products. Factors associated with receipt of transfusions included known bleeding disorders, anticoagulation medication use, nasal procedure within 30 days, nasal malformations, and oncological conditions, with oncological conditions having the greatest effect size (adjusted odds ratio, 50.21; 95% CI 10.70-235.61) (Table 2).

Conclusion(s): Children with age ≥10 years, White or Caucasian race, Hispanic or Latino ethnicity, active bleeding, >1 nosebleeds within 24 hours, and prior history of nosebleeds often receive non-urgent laboratory evaluation for epistaxis despite no increased odds to receive transfusions in the ED. Further studies are required to better define the prevalence of anemia and thrombocytopenia in children who present to the ED with epistaxis and do not receive transfusion therapy.

Table 1. Association Model of Risk Factors for Receipt of Laboratory Evaluation
CI, confidence interval; CBC, complete blood cell count; OR, odds ratio

Table 2. Association Model of Risk Factors for Receipt of Transfusions
CI, confidence interval; OR, odds ratio

Table 1. Association Model of Risk Factors for Receipt of Laboratory Evaluation
CI, confidence interval; CBC, complete blood cell count; OR, odds ratio

Table 2. Association Model of Risk Factors for Receipt of Transfusions
CI, confidence interval; OR, odds ratio