title: Predictors of bleeding disorders in children with epistaxis: value of preoperative tests and clinical screening.
abstract: OBJECTIVE
  To identify prevalence of previously undiagnosed bleeding disorders in children with severe epistaxis who failed medical therapy requiring intraoperative nasal cautery.
  
  
  METHODS
  Retrospective chart review 10/15/2006-12/31/2010.
  
  
  METHODS
  Single provider outpatient otolaryngology clinic.
  
  
  METHODS
  
  
  
  METHODS
  children (<19 years) with epistaxis referred to otolaryngology, no known bleeding disorder, failed medical therapy and received surgical nasal cautery.
  
  
  METHODS
  duration/severity of epistaxis, bleeding history, family history of bleeding. A screening CBC, PT and PTT were performed on all patients.
  
  
  RESULTS
  Of 248 subjects referred for epistaxis, 47(19%) met inclusion criteria (mean age 9.2±0.5 years; 61.7% male). 31.9% (15/47) had abnormal coagulation studies but on repeat testing only 2 patients had persistent coagulation abnormalities. 15 patients were referred to hematology, 5 were diagnosed with a bleeding disorder (3 - type 1 von Willebrand's disease, 1 - platelet aggregation disorder, 1 - mild factor VII deficiency). Out of the entire cohort 10.6% (5/47) had a bleeding diathesis. Clinical predictive factors for having a bleeding diathesis were explored and included previous emergency room visits for epistaxis (p=0.04). A trend was found in those presenting with epistaxis at a younger age (p=0.07).
  
  
  CONCLUSIONS
  Children with recurrent epistaxis despite medical therapy are at higher risk of having a bleeding disorder. In this highly selected group of patients 10.6% (5/47) were found to have a bleeding disorder. Screening coagulation studies (PT, PTT) only revealed 20% (1/5) of patients with a bleeding disorder. Only a subsequent comprehensive hematology evaluation revealed the diagnosis in the majority of patients.
authors.affiliation: Division of Otolaryngology in the Department of Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 1 Wood Center,Philadelphia, PA 19104, USA. elden@email.chop.edu
authors.forename: Lisa
authors.initials: L
authors.lastname: Elden
authors.forename: Megan
authors.initials: M
authors.lastname: Reinders
authors.forename: Char
authors.initials: C
authors.lastname: Witmer
mesh_terms: D001780:Blood Coagulation Tests; D002425:Cautery / Q000379:methods; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D004844:Epistaxis / Q000097:blood / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006474:Hemorrhagic Disorders / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome