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Identified characteristics of epistaxis indicative of asphyxiation

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


This review excluded infants with epistaxis as a consequence of nasal trauma or underlying bleeding disorders


The aim of the study is to determine the probability of asphyxiation in an infant presenting with epistaxis


Of 367 full text articles assessed, 7 articles (6 studies) met the inclusion criteria 1-7 (overlapping data between 4 and 5)


Study designs:  

  • 1 case control 3
  • 2 cross sectional 4,5,6
  • 3 case series 1,2,7
  • 4 studies included comparative data 2-6


In 5 studies the children were aged less than 1 year 1-3,6,7 and in one study they were aged upto 2 years 4,5


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  1. Becroft DM, Thompson JM, Mitchell EA. Nasal and intrapulmonary haemorrhage in sudden infant death syndrome. Archives of Disease in Childhood. 2001;85(2):116-120 [Pubmed]

  2. Krous HF, Nadeau JM, Byard RW, Blackbourne BD. Oronasal blood in sudden infant death. American Journal of Forensic Medicine & Pathology. 2001;22(4):346-351 [Pubmed]

  3. Krous HF, Chadwick AE, Haas EA, Stanley C. Pulmonary intra-alveolar hemorrhage in SIDS and suffocation. Journal of Forensic & Legal Medicine. 2007;14(8):461-470 [Pubmed]

  4. McIntosh N, Mok JYQ, Margerison A. Epidemiology of oronasal hemorrhage in the first 2 years of life: Implications for child protection. Pediatrics. 2007;120(5):1074-1078 [Pubmed]

  5. McIntosh N, Mok JYQ, Margerison A, Armstrong L, Mathews A, Robertson AK, Street J, Sweeney S, Chalmers J. The epidemiology of oro-nasal haemorrhage and suffocation in infants admitted to hospital in Scotland over 10 years. Archives of Disease in Childhood. 2010;95(10):810-816 [Pubmed]

  6. Paranjothy S, Fone D, Mann M, Dunstan F, Evans E, Tomkinson A, Sibert J, Kemp A. The incidence and aetiology of epistaxis in infants: a population-based study. Archives of Disease in Childhood. 2009;94(6):421-424 [Pubmed]

  7. Southall DP, Plunkett MC, Banks MW, Falkov AF, Samuels MP. Covert video recordings of life-threatening child abuse: lessons for child protection. Pediatrics. 1997;100(5):735-760 [Pubmed]


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