TY  - JOUR
PY  - 2015//
TI  - A systematic review of the probability of asphyxia in children aged <2 years with unexplained epistaxis
JO  - Journal of pediatrics
A1  - Rees, Philippa
A1  - Kemp, Alison
A1  - Carter, Ben
A1  - Maguire, Sabine
SP  - 178
EP  - 184.e10
VL  - 168
IS  - 
N2  - OBJECTIVE: To determine the proportion of children aged <2 years who have been asphyxiated presenting with epistaxis in the absence of trauma or medical explanation and to identify the characteristics of the clinical presentation indicative of asphyxiation. STUDY DESIGN: An all-language systematic review was conducted by searching 10 databases from 1900 to 2015 and gray literature to identify high-quality studies that included children with epistaxis aged <2 years (alive or dead) with explicit confirmation of intentional or unintentional asphyxiation (upper airway obstruction). Studies of traumatic or pathological epistaxis were excluded. For each comparative study, the proportion of children presenting with epistaxis that were asphyxiated is reported with 95% CI. <br><br>RESULTS: Of 2706 studies identified, 100 underwent full review, resulting in 6 included studies representing 30 children with asphyxiation-related epistaxis and 74 children with non-asphyxiation-related epistaxis. The proportion of children presenting with epistaxis that had been asphyxiated, reported by 3 studies, was between 7% and 24%. Features associated with asphyxiation in live children included malaise, altered skin color, respiratory difficulty, and chest radiograph abnormalities. There were no explicit associated features described among those children who were dead on arrival. <br><br>CONCLUSION: There is an association between epistaxis and asphyxiation in young children; however, epistaxis does not constitute a diagnosis of asphyxia in itself. In any infant presenting with unexplained epistaxis, a thorough investigation of etiology is always warranted, which must include active exploration of asphyxia as a possible explanation.<p />  <p>Language: en</p>
LA  - en
SN  - 0022-3476
UR  - http://dx.doi.org/10.1016/j.jpeds.2015.09.043
ID  - ref1
ER  -