(1020) Efficacy of Topical and Procedural Interventions for Epistaxis in Children

Introduction: Epistaxis is a common problem affecting pediatric patients that is often self-resolving, though may require surgical intervention if recurrent or severe. The goal of this study is to assess the efficacy of topical therapy for recurrent epistaxis and identify risk factors for failure, as well as recurrence rate after operative intervention.

Methods: Retrospective chart review was conducted examining patients presenting to pediatric otolaryngology outpatient clinic at an urban academic hospital between 2010 and 2019. Children less than 18 years old with an ICD-10 diagnosis of epistaxis were identified. The electronic medical record was used to identify patient demographics, medical history, and treatments. The primary outcome measure was resolution of epistaxis following topical therapy. Secondary outcome measures compared differences between groups that failed medical treatment and required cautery. Statistical analysis is ongoing, including chi squared and odds ratio analysis.

Results: In total, 373 patients were identified with 65.6% (n = 245) being male and 34.4% (n = 128) being female. There was a diverse sample of patients representing multiple ethnicities and ages. The mean age at presentation was 7.5 years. The mean number of bleeds per week prompting referral was ​3.6. Of the total, 350 children underwent treatment with topical therapy including saline based gel, Vaseline, and mupirocin. Of them, 71% had resolution of symptoms with topical therapy; 18% (n = 63) required clinic cautery after failing topical therapy, and 13% (n = 52) underwent cautery in the operating room (OR) due to an inability to tolerate clinic intervention or after failing clinic cautery. Recurrence rates following procedural interventions were 50% for office cauterization and 32% for OR cauterization, though this was not statistically significant (p = 0.06).

Conclusions: We present outcomes following medical and surgical management of pediatric epistaxis in a diverse urban population. Treatment with first-line topical therapy was highly efficacious and when failure did occur, OR cauterization had lower recurrence rates compared to cauterization in office.