Author(s)
Hawa M. Ali, BS1
Hanan Zavala, PhD2
Sivakumar Chinnadurai, MD, MPH2
Brianne Roby, MD2
Affiliation(s)
1Univ. of Minnesota, Minneapolis, MN, 2Pediatric ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN.;
Abstract:
Background: Nasal septal hematoma (NSH) is a rare complication of nasal trauma in children. The diagnosis of NSH is often overlooked, which can result in septal cartilage destruction and serious complications. Literature on NSH is scarce and no data exists to characterize time to diagnosis or healthcare utilization patterns in a pediatric population.
Objectives: To determine the average time from initial injury to diagnosis of NSH. Additional end points include average number of medical evaluations prior to diagnosis and long-term complications.
Methods: A retrospective chart review was performed on all patients diagnosed with NSH at a tertiary pediatric hospital between 10/1/2016 to 4/1/2019. Average time to diagnosis was defined as time between initial trauma to date of diagnosis. Number of evaluations was defined as all medical evaluations prior to diagnosis.
Results: There were 2,700 charts reviewed, with 5 patients with acute NSH identified. All patients were male, and trauma was the cause in 4/5 patients. Pain (60%), rhinorrhea (40%) and nasal obstruction (40%) were the most common symptoms. Average time to diagnosis was 9 days (4-21 days), with an average of 1.4 evaluations (0-3 evaluations) prior to diagnosis. Initial evaluations included primary care (60%), emergency departments (40%) and urgent care (20%). In 40% of patients, NSH was missed in multiple clinical settings. Sixty percent of patients developed septal abscess. All patients were treated with drainage of hematoma or abscess; 60% received antibiotics. Two patients experienced long-term complications including saddle nose deformity and severe nasal obstruction.
Conclusions: NSH is a rare but serious emergency. This study demonstrated it can take many days and multiple medical evaluations until diagnosis is made. Emergency and primary care providers need increased awareness of this rare clinical entity to prevent abscess formation or long-term saddle nose deformity.