Epistaxis duration predicts bleeding in immune thrombocytopenia: a cohort study
Arch Dis Child
. doi:

Investigators from multiple institutions in the United Kingdom (UK) conducted a retrospective study to assess the association between severity of epistaxis at presentation in children with immune thrombocytopenia (ITP) and subsequent bleeding events. For the study, they reviewed data in the UK Paediatric ITP registry, which included information on new cases of ITP in children 2 months to 16 years old between 2006 and 2020. Clinicians or database managers entered demographic and clinical information on new cases at presentation and for at least the subsequent 6 months, with annual updates on patients with ongoing ITP. For the current study, participants were children in the registry who had bleeding data at presentation. The severity of bleeding was categorized as mild, moderate, or severe using the Bolton-Maggs scoring system. The primary study outcome was a subsequent bleeding event within 12 months of presentation that was classified as severe. Secondary outcomes included moderate or severe bleeding events and drop in hemoglobin (Hb) ≥20 g/L. The exposure of interest was duration of epistaxis at initial presentation of ITP and was classified as none, <10 minutes, 10-30 minutes, or >30 minutes. Logistic regression was used to assess the association between duration of epistaxis at presentation and the outcomes after correcting for age, platelet count, number of other bleeding sites, and, for moderate to severe bleeding, atypical features.

Data on 1,793 children with ITP who had bleeding at presentation were included in the analyses. The mean age of these patients was 5.7 years; 49% presented with mild bleeding, 46% with moderate, and 5% with severe. Among those with bleeding at presentation, 519 children had epistaxis at presentation, including 334 with a duration <10 minutes, 88 with epistaxis lasting 10-30 minutes, and 97 with a duration of >30 minutes. Follow-up data were available on 1,792 children to assess the outcome of severe bleeding, 1,768 for combined moderate or severe bleeding events, and 1,635 patients for the hemoglobin decrease outcome. Patients with missing data for an outcome were considered to not have that outcome. Compared to those with no epistaxis, patients with epistaxis lasting >30 minutes at presentation were significantly more likely to have a subsequent severe bleeding event (adjusted odds ratio [aOR], 4.73; 95% CI, 1.43, 15.67). There was no statistically significant relationship between epistaxis <10 minutes (aOR, 1.40; 95% CI, 0.43, 4.57), or epistaxis duration 10-30 minutes (aOR, 1.35; 95% CI, 0.17, 10.83) and a subsequent severe bleeding event. Epistaxis duration >30 minutes also was associated significantly with moderate to severe subsequent bleeding events (aOR, 2.36; 95% CI, 1.33, 4.20) and drop in Hb ≥20 g/L (aOR, 2.91; 95% CI, 1.23, 6.91). Epistaxis at presentation of shorter duration was not associated significantly with either of these outcomes.

The authors conclude that epistaxis >30 minutes at...

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