title: Paediatric haemoptysis and the otorhinolaryngologist: Systematic review.
abstract: OBJECTIVE
  Childhood haemoptysis is an uncommon presentation to the otolaryngologist but has a varied aetiology and can be life-threatening. We performed a systematic review of the literature to assess paediatric otolaryngologists' experience with haemoptysis, the aetiology involved, investigations performed and management provided. Using this, we produce an evidence-based treatment algorithm to guide clinicians.
  
  
  METHODS
  Systematic literature review of the PubMed, EMBASE and Cochrane Collaboration using the search terms 'paediatric', 'child', 'neonate', 'adolescent', 'haemoptysis', 'coughing blood', 'spitting blood' and 'otorhinolaryngology'.
  
  
  RESULTS
  Five articles were retrieved meeting the search criteria including 106 patients (age range 3 weeks to 18 years). The 3 most common aetiologies were bronchitis (n = 9), idiopathic/ no cause found (n = 9) and pneumonia (n = 7). Flexible bronchoscopy was the commonest investigation performed in non-active cases whilst rigid bronchoscopy was performed for active haemoptysis to provide therapeutic interventions. Chest x-ray was performed as a screening investigation rather than CT scan, which was reserved to assess pathology further, in recurrent cases and when x-ray is inconclusive. Management depended on aetiology. There was no difference in aetiology between age ranges.
  
  
  CONCLUSIONS
  Haemoptysis aetiology is varied and non-cancerous but is life-threatening in cases of pulmonary agenesis and vasculature abnormalities. No cause may be found. Clinicians' investigations and management plans should be based on the established care of haemoptysis. There is no difference between otolaryngologists and respiratory physicians' experience.
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Sick Children Edinburgh, 9 Sciennes Road, Edinburgh, EH9 1LF, United Kingdom. Electronic address: miles.bannister@hotmail.co.uk.
authors.forename: Miles
authors.initials: M
authors.lastname: Bannister
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis*; D000293:Adolescent; D001991:Bronchitis / Q000150:complications / Q000175:diagnosis*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis*; D006469:Hemoptysis / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities*; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis*; D010036:Otolaryngology; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis*; D011651:Pulmonary Artery / Q000002:abnormalities; D011667:Pulmonary Veins / Q000002:abnormalities; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D054079:Vascular Malformations / Q000150:complications / Q000175:diagnosis*
keywords: Airway assessment; Congenital abnormality; Foreign body; Haemoptysis; Infection