Emergency care for posttonsillectomy and postadenoidectomy hemorrhage

Abstract

There are an estimated 4,300 cases of postoperative hemorrhage after tonsillectomy in the United States each year. Most patients seek care in the Emergency Department for this potentially fatal condition. This study was performed to characterize the clinical presentation of patients seeking Emergency Department (ED) care for posttonsillectomy and postadenoidectomy hemorrhage (PTAH). In addition, the investigators attempted to describe the ED treatment for PTAH. A retrospective review of ED and inpatient medical records was executed for patients presenting to the ED with PTAH from June 1, 1983 to May 31, 1993. All patients presenting to the ED who received a final ED diagnosis of PTAH were included in the study. The setting included two community-based teaching hospitals that share a single emergency medicine residency. The combined ED census averaged 72,000 annual visits over the study period. The ED population included both children and adults. Neither hospital had an otolaryngology residency, nor was there 24 hour in-hospital otolaryngology staffing. Factors that were reviewed included patient age, gender, final disposition, presenting vital signs, time from the initial surgery to the time of bleeding, ED treatment, and the interaction with the on-call otolaryngologist. Subpopulations were defined primarily by age (child versus adult) and disposition (home versus hospital). χ² Analysis was used for most comparisons. When χ² analysis showed an association, the phi (Ф) coefficient was calculated to determine the strength of the association. When appropriate, means were compared using the Student's two-tailed t test. There were 106 visits involving 93 patients. There were 51 hospital admissions (48%), and 55 (52%) visits resulted in discharge to home. Of the 93 patients involved, 57 (61%) were children (≤17 years), accounting for 61 total visits; 36 (39%) were adults (≥18 years), accounting for 45 visits. Children with PTAH were more likely to be admitted than adults (χ², P = .008; Ф test = 0.25) Procedures to stop PTAH were frequently performed in the ED, often by emergency medicine physicians; silver nitrate cautery was the most frequent. Adults were more likely to receive a minor hemostatic procedure, yet children were more likely to receive a blood transfusion initiated while in the ED or require surgery to achieve control of the bleeding.