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Comparative studies of children with epistaxis

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.


Of the six included studies, four (five articles) were comparable 1-5


The probability of asphyxiation, either intentional or unintentional, in a child with epistaxis is 19.6% (95% CI, 12.7-28.8%)


The included studies had both fatal and non-fatal cases.  For the non-fatal cases clinical features associated with asphyxiation for those with epistaxis included pallor, cyanosis, respiratory difficulty, altered heart rate and reduced consciousness 3,4


A retrospective study of infants admitted with epistaxis identified one child with asphyxia as an aetiology where the mechanism was inflicted smothering and the infant had co-existent hypoxicischaemia on brain MRI 5


For the fatal cases the asphyxiated children were noted to have intra-pulmonary haemorrhages or intrathoracic, or pleural petechiae 1,2


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  1. 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]

  2. 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]

  3. 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]

  4. 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]

  5. 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]


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