Author(s)
S. Yuen
K. Kawai
D. Roberson
R. Murray
Affiliation(s)
Boston Children's Hospital; Otolaryngology Associates; P.C.
Abstract:
Three to ten percent of tonsillectomy patients have delayed bleeding, typically within 14 days of the procedure. On presentation to the Emergency Department (ED), some have active bleeding while others do not. It is not known if those without active bleeding require observation. We examined a retrospective series of such patients who were admitted for observation. This is a retrospective series of 372 patients admitted for observation from 2010-2014 at a tertiary pediatric hospital’s ED. Patients had a history of post-tonsillectomy bleeding and had no evidence of active bleeding. Demographics and clinical data were extracted from the medical record. The primary endpoint was active bleeding requiring cauterization. Of 372 patients who were readmitted for observation with no active bleed, 41 (11%) required cauterization for subsequent bleeding. 34 of these 41 (83%) bled within 24 hours of observation. No demographic or clinical variables predicted the likelihood of rebleeding. Eleven percent of patients who present to the ED with a post-tonsillectomy bleed and negative exam will require cautery during observation. Unfortunately, no predictors of rebleeding were found in this study. These data suggest patients who present with a history of bleeding but have no evidence of active bleeding should be considered for 24 hour observation.