Joshua Verhagen, Elle Nuttall, Samuel Floren, Daniel Traverzo, Tony Kille
{"title":"Analysis of an Observational Versus Surgical Approach for Pediatric Post-Tonsillectomy Hemorrhage.","authors":"Joshua Verhagen, Elle Nuttall, Samuel Floren, Daniel Traverzo, Tony Kille","doi":"10.1002/lary.70140","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Post-tonsillectomy hemorrhage (PTH) is a common complication in pediatric patients, yet management strategies vary due to limited outcome data. Historically, all patients at our institution with postoperative bleeding or visible clot were taken to the OR. In 2018, a new protocol was introduced in which patients with a visible clot but no active bleeding were managed conservatively. This study evaluates the efficacy and revisit outcomes of this observational approach versus immediate surgical intervention.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a tertiary center over two 3-year periods. Pediatric patients (< 18 years) presenting to the ED (emergency department) with PTH were categorized into pre-protocol (n = 86, surgical) and post-protocol (n = 134, observational) cohorts. Outcomes included revisit rates, surgical intervention rates, and hospital length of stay. Statistical analysis was performed using two-sample t tests and Fisher's exact tests.</p><p><strong>Results: </strong>The post-protocol cohort had a higher proportion of patients presenting with PTH (3.86% vs. 5.88%, p = 0.0018), but fewer underwent surgery (54.65% vs. 26.87%, p < 0.0001). No significant differences were found in repeat visits leading to surgery or multiple surgical interventions. More patients with a visible clot avoided surgery post-protocol (3.49% vs. 29.85%, p < 0.0001). However, the average hospital stay was longer (9.25 vs. 13.13 h, p = 0.0774).</p><p><strong>Conclusion: </strong>An observational approach for pediatric PTH patients with clot-only presentation significantly reduced the need for surgical intervention. This strategy may minimize unnecessary procedures and improve care quality.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":49921,"journal":{"name":"Laryngoscope","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laryngoscope","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/lary.70140","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Post-tonsillectomy hemorrhage (PTH) is a common complication in pediatric patients, yet management strategies vary due to limited outcome data. Historically, all patients at our institution with postoperative bleeding or visible clot were taken to the OR. In 2018, a new protocol was introduced in which patients with a visible clot but no active bleeding were managed conservatively. This study evaluates the efficacy and revisit outcomes of this observational approach versus immediate surgical intervention.
Methods: A retrospective cohort study was conducted at a tertiary center over two 3-year periods. Pediatric patients (< 18 years) presenting to the ED (emergency department) with PTH were categorized into pre-protocol (n = 86, surgical) and post-protocol (n = 134, observational) cohorts. Outcomes included revisit rates, surgical intervention rates, and hospital length of stay. Statistical analysis was performed using two-sample t tests and Fisher's exact tests.
Results: The post-protocol cohort had a higher proportion of patients presenting with PTH (3.86% vs. 5.88%, p = 0.0018), but fewer underwent surgery (54.65% vs. 26.87%, p < 0.0001). No significant differences were found in repeat visits leading to surgery or multiple surgical interventions. More patients with a visible clot avoided surgery post-protocol (3.49% vs. 29.85%, p < 0.0001). However, the average hospital stay was longer (9.25 vs. 13.13 h, p = 0.0774).
Conclusion: An observational approach for pediatric PTH patients with clot-only presentation significantly reduced the need for surgical intervention. This strategy may minimize unnecessary procedures and improve care quality.
目的：扁桃体切除术后出血（PTH）是儿科患者常见的并发症，但由于结果数据有限，治疗策略各不相同。从历史上看，我们机构所有术后出血或可见凝块的患者都被送往手术室。2018年，引入了一项新方案，对有可见血块但没有活动性出血的患者进行保守治疗。本研究评估了这种观察性方法与立即手术干预的疗效并重新审视了结果。方法：回顾性队列研究在一个三级中心进行了两个为期三年的研究。结果：方案后队列中出现PTH的患者比例较高（3.86% vs. 5.88%, p = 0.0018），但接受手术治疗的患者比例较低（54.65% vs. 26.87%, p）。结论：观察性方法治疗仅出现凝块的儿科PTH患者可显著降低手术干预的必要性。这种策略可以减少不必要的程序，提高护理质量。证据等级：3；
期刊介绍：
The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope.
• Broncho-esophagology
• Communicative disorders
• Head and neck surgery
• Plastic and reconstructive facial surgery
• Oncology
• Speech and hearing defects
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
