A double-blind randomized controlled trial of management of recurrent nosebleeds in children.
BACKGROUND
To establish whether a treatment regimen of silver nitrate cautery and 4 weeks of antiseptic nasal cream is superior to antiseptic cream treatment alone in the management of pediatric epistaxis.


METHODS
Double-blind randomized controlled trial.


METHODS
Children with epistaxis and visible anterior septal vessels were invited to participate. Patients were randomized to receive treatment or control. Treatment patients received silver nitrate cautery, followed by antiseptic cream for 4 weeks. Control patients received sham cautery followed by antiseptic cream for 4 weeks.


RESULTS
A total of 109 patients were randomized and results were available for 93 (85%). Of those receiving cautery, 21 (45.7%) of 46 had no bleeding in the 4 weeks before follow-up. Of those receiving only antiseptic cream 14 (29.8%) of 47 had no bleeding. (chi(2) = 2.49; P = 0.114). More children in the active treatment group had an improvement in their symptoms compared with controls (42 of 46; 91.3%) in the treatment group vs 33 of 47 (70.2%) controls (chi(2) = 6.626; P = 0.01; relative risk reduction = 71 percent, number needed to treat = 4.7).


CONCLUSIONS
When using subjective improvement in symptoms as the outcome measure, silver nitrate cautery with antiseptic cream twice daily for 4 weeks appears to give a small but statistically significant benefit when compared to antiseptic cream alone.
Calder
Nicholas
N
Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland. ncalder@hotmail.com
Kang
Swee
S
Fraser
Lyndsay
L
Kunanandam
Tash
T
Montgomery
Jennifer
J
Kubba
Haytham
H
D000281:Administration, Intranasal; D000287:Administration, Topical; D000293:Adolescent; D002425:Cautery / Q000379:methods*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D004844:Epistaxis / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009355:Neomycin / Q000627:therapeutic use*; D012008:Recurrence; D012835:Silver Nitrate / Q000627:therapeutic use*; D016896:Treatment Outcome
D004338:Drug Combinations; C070815:Naseptin; D012835:Silver Nitrate; D009355:Neomycin; D002710:Chlorhexidine