Interventions for recurrent idiopathic epistaxis (nosebleeds) in children

 

Abstract

Background

Recurrent idiopathic epistaxis (nosebleeds) in children is repeated nasal bleeding in patients up to the age of 16 for which no specific cause has been identified. Although nosebleeds are very common in children, and most cases are self-limiting or settle with simple measures (such as pinching the nose), more severe recurrent cases can require treatment from a healthcare professional. However, there is no consensus on the effectiveness of the different clinical interventions currently used in managing this condition.

Objectives

To assess the effects of different interventions for the management of recurrent idiopathic epistaxis in children.

Search methods

We searched the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 4, 2007), MEDLINE (January 1950 to October 2007), EMBASE (January 1974 to October 2007), CINAHL (January 1982 to October 2007) and reference lists of relevant articles.

Selection criteria

We identified all randomised controlled trials (with or without blinding) in which any surgical or medical intervention for the treatment of recurrent idiopathic epistaxis in children was evaluated in comparison with either no treatment, a placebo, or another intervention, and in which the frequency and severity of episodes of nasal bleeding following treatment was stated or calculable. The full text articles of all the retrieved trials of possible relevance were reviewed by the two authors and the inclusion criteria applied independently.

Data collection and analysis

We graded trials for methodological quality using the Cochrane approach. Data extraction was performed in a standardised manner by one author and rechecked by the other, and where necessary investigators were contacted to obtain missing information. A meta-analysis was not undertaken because of the heterogeneity of the treatments, procedures and quality of the included trials. A narrative overview of the results is therefore presented.

Main results

Three studies (two randomised controlled trials (RCTs) and one controlled clinical trial (CCT)) involving 256 participants satisfied the inclusion criteria. One RCT compared Naseptin® antiseptic cream with no treatment, the second RCT compared Vaseline® petroleum jelly with no treatment and the CCT compared Naseptin® antiseptic cream with silver nitrate cautery. Overall, results were inconclusive, with no statistically significant difference found between the compared treatments. No serious adverse effects were reported from any of the interventions, although children receiving silver nitrate cautery reported that it was a painful experience (despite the use of local anaesthetic).

Authors' conclusions

The optimal management of children with recurrent idiopathic epistaxis is unknown. High quality randomised controlled trials comparing interventions either with placebo or no treatment, and with a follow-up period of at least a year, are needed to assess the relative merits of the various treatments currently in use.

 

Plain language summary

Interventions for recurrent nosebleeds of unknown cause in children

Nosebleeds in children usually just stop by themselves or after pinching the nose. However some children get repeated nosebleeds with no specific cause (recurrent idiopathic epistaxis). The most common treatments are cautery and/or antiseptic cream. Cautery (sealing with heat) can be painful even with local anaesthetic, and usually involves using a silver nitrate stick to seal off a visible blood vessel inside the nose that may be rupturing. Other options include ointments and nasal sprays. The review of trials found there is not enough evidence to compare the effectiveness of different treatment options. More research is needed to show the best options for reducing recurrent nosebleeds of unknown cause in children.

 

摘要

背景

兒童復發性自發性流鼻血的處置

兒童復發性自發性流鼻血是指小於16歲兒童無法找出特定原因卻反覆流鼻血。雖然兒童流鼻血很常見，而且多數是自限性、可用簡單的方法(例如捏鼻子)來控制，但較嚴重的復發病例可能需要專業的醫療來治療。目前處理這種情況有多樣的臨床處置，但對這些方法的效果無共識

目標

評估對兒童復發性自發性流鼻血的各種處置之效果

搜尋策略

搜尋了the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 4, 2007), MEDLINE (January 1950 to October 2007), EMBASE (January 1974 to October 2007), CINAHL (January 1982 to October 2007)及相關文章的參考文獻

選擇標準

評估所有對兒童復發性自發性流鼻血的手術或藥物處置的隨機對照試驗(無論是否有單盲、雙盲)，比較無治療、安慰劑、或其他處置，及計算治療後的流鼻血頻率和嚴重度。兩位作者閱讀所有相關的試驗文章，並各自依收集標準摘選研究

資料收集與分析

用Cochrane方法為試驗的方法學品質分等級。摘選的資料先由一位作者依照標準化步驟評估，再由另一位檢驗，並聯繫相關的研究者以得不足的資訊。由於治療、步驟的多樣化，且所收集試驗的品質等級不同，無法做統合分析。結果以敘述性的摘要提出

主要結論

3個研究(2個隨機對照試驗及1個臨床對照試驗)含256位病患符合入選標準。1個隨機對照試驗比較Naseptin抗菌藥膏與無治療，另一個隨機對照試驗比較凡士林凝膠與無治療，而臨床對照試驗比較Naseptin抗菌藥膏與硝酸銀燒灼。整體來說，因為在比較的治療結果中沒有統計學上意義，所以無得到結論。在所有的處置中沒有嚴重的副作用被報告，但接受硝酸銀燒灼的兒童會有疼痛感(儘管已用局部麻醉劑)

作者結論

最佳的兒童復發性自發性流鼻血處置仍不明，我們需要一個優良設計品質的隨機對照試驗來比較任何處置與安慰劑或無治療，並有至少一年的追蹤，來評估目前所用的各種治療的優點

翻譯人

本摘要由國泰綜合醫院方德詠翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

兒童復發性不明原因流鼻血的處置:兒童流鼻血常會自動停止或在捏鼻子後停止，然而有些兒童會不明原因地反覆流鼻血(復發性自發性流鼻血)，最常用的治療有燒灼或抗菌藥膏。即使在局部麻醉下，燒灼(利用熱度來密封)仍會造成疼痛，通常是用硝酸銀棉棒來密封鼻內可見的血管，但可能會造成血管破裂。其他的方式包括軟膏及鼻噴劑。一些研究的回顧發現沒有足夠證據來比較各種治療的效果，需要更多研究來顯示減少兒童復發性不明原因流鼻血的最佳治療選擇