Nosebleeds in Children as a Potential Marker for Nonaccidental Injury and Serious Underlying Pathology: How Aware Are Hospital Clinicians?
Table 1
Likert scale questionnaire and results.
Questions
“Strongly Agree” or “Agree”
“Neither Agree nor Disagree”
“Disagree” or “Strongly Disagree”
(1)
A 6-month-old boy is brought in by his mother with a nosebleed. Just as you are reassuring the mother your colleague pulls you to a corner and states that you need to be very careful with your clinical assessment as epistaxis in a child of this age can be a sign of child abuse. Do you:
24
8
7
(2)
He suggests that your history should include a thorough questioning of how this event occurred, any previous such events, and any previous injuries the child may have sustained, including hospital admissions. If there is any doubt whatsoever, you should be ready to seek senior help and make enquiries from social services and mention your concerns. Do you:
35
2
2
(3)
The mother of the child tells you that the baby was asleep in his cot, and when she heard him crying on the baby monitor and went to fetch him, she noticed the bleeding nose. The nurse working with you says that this kind of spontaneous nose bleed is not uncommon in babies and starts reassuring the mother. Do you:
7
10
22
(4)
You discuss the child with an ENT colleague on the ward. He tells you that epistaxis is quite common in children and laughs at you when mention that you are concerned about physical abuse. Do you:
3
7
29
(5)
The next day a 9-year-old girl presents with a nosebleed. On taking the history you learn she has had two previous such episodes earlier this year. The nosebleed started spontaneously, resolved with first aid measures, and the girl is haemodynamically stable. Her mother is eager to take her home. Just as you are about to discharge them, your colleague asks if you have taken blood to check Hb levels, platelet count, and INR. Do you:
20
4
15
(6)
He also asks if your history involved questions to inquire about possible underlying causes such as hereditary haemorrhagic telangiectasia, idiopathic thrombocytopenic purpura, leukemia/lymphoma, and haemophilia. Do you:
