(509) Treatment of Pediatric Epistaxis: A Systematic Review and Meta-Analysis

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

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Presenting Author(s)

Ahmad J. Kasabali, Other

Medical Student
LSU Health Shreveport School of Medicine, Shreveport, LA, USA
Shreveport, Louisiana, United States

Co-Author(s)

Taylor L. Powell, MS

Medical Student
Louisiana State University School of Medicine Shreveport
Shreveport, Louisiana, United States
Nrusheel Kattar, MD

Resident
Department of Otolaryngology-Head and Neck Surgery, LSU-Health Sciences Center, Shreveport, LA, USA
Shreveport, Louisiana, United States
Mark I. Knackstedt, MD

Resident
LSU Health and Science Center Shreveport
Shreveport, Louisiana, United States

Senior Author(s)

OA

Omar G. Ahmed, MD

Assistant Professor
Department of Otolaryngology-Head and Neck Surgery, Houston Methodist, Houston, TX, USA
Houston, Texas, United States
MY

Michael T. Yim, MD

LSU Health Shreveport School of Medicine, Shreveport, LA, USA; Department of Otolaryngology-Head and Neck Surgery, LSU-Health Sciences Center, Shreveport, LA, USA, USA

Disclosure(s):

Taylor L. Powell, MS: No relevant relationships to disclose.

Nrusheel Kattar, MD: No relevant relationships to disclose.

Mark I. Knackstedt, MD: No relevant relationships to disclose.

Introduction: In this systematic review and meta-analysis, we review current literature pertaining to primary epistaxis in children and evaluate the efficacy of different modalities of treatment.

Methods: PubMed, Embase, and Web of Science databases were queried and this review was conducted in accordance with the 2020 PRISMA guidelines. A meta-analysis of pooled treatment success rates with an inverse variance statistical method and fixed effects analysis model was performed. The methodological index for non-randomized studies (MINORS) criteria was used to assess the quality of studies.

Results: Of 579 abstracts initially screened, 17 full-text articles were included in this review, consisting of 1,315 patients. Of the included studies which reported ages and gender, we evaluated a pediatric population averaging 9.7 years old; 61% of the patients were male while 39% were female. The primary outcome was the rate of complete resolution of epistaxis on follow-up. Data was pooled from 14 of 17 studies into a meta-analysis which demonstrated the following pooled rates of complete resolution of epistaxis: observation - 42% (3 studies, 95% CI 0.31-0.53); topical treatments (emollients, antiseptic creams) - 65% (4 studies, 95% CI 0.58-0.72); silver nitrate cautery - 79% (6 studies, 95% CI 0.74-0.84); silver nitrate cautery with topical treatments- 69% (2 studies, 95% CI 0.65-0.73); propranolol - 86% (2 studies, 95% CI 0.77-0.95); microwave ablation - 93% (2 studies, 95% CI 0.88-0.98). The average MINORS score of included studies was 12.9.

Conclusions: Silver nitrate cautery and topical treatments, either in conjunction or individually, are effective treatments for pediatric epistaxis. Oral propranolol and in-clinic microwave ablation are promising first-/second- line treatments that warrant further study.