Table of Contents
ISRN Otolaryngology
Volume 2011, Article ID 909570, 3 pages
Research Article

Nosebleeds in Children as a Potential Marker for Nonaccidental Injury and Serious Underlying Pathology: How Aware Are Hospital Clinicians?

Paediatric Department, Good Hope Hospital, Rectory Road, Sutton Coldfield, Birmingham B75 7RR, UK

Received 18 July 2011; Accepted 17 August 2011

Academic Editor: C.-H. Wang

Copyright © 2011 Abdul Qader Ismail and Anjum Gandhi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Paediatric epistaxis is common and usually of benign origin. However, the differential diagnosis includes serious underlying pathology (e.g., bleeding disorders and blood cancers) and in the very young can be a marker of potential physical abuse. To assess if paediatric and A&E doctors were aware of the important differential, we asked them to complete a Likert scale questionnaire on several different clinical scenarios. Our results show that a significant proportion of doctors of all grades and in both specialties were either not aware of or not concerned about epistaxis in an infant as a possible sign of nonaccidental injury and were not willing to carry out simple blood tests to investigate recurrent nosebleeds in an older child. Our results highlight the need for education and evidence-based guidelines to avoid missing important, if infrequent, causes of paediatric epistaxis, both in the hospital and community setting.