Cautery or cream for epistaxis in children
Date First Published:
September 5, 2000
Last Updated:
July 18, 2001
Report by:
Angaj Ghosh, Senior Clinical Fellow (Manchester Royal Infirmary)
Search checked by:
Rupert Jackson, Manchester Royal Infirmary
Three-Part Question:
In [children with spontaneous epistaxis and no underlying disease] is [silver nitrate cautery better than nasal antiseptic cream] at [stopping bleeding and preventing recurrences]?
Clinical Scenario:
A child presents to the emergency department with a nosebleed that came on spontaneously and which has not responded to simple first aid measures. The bleed appears to be from the front of the nose and the patient has no underlying disease. You wonder whether silver nitrate cautery or application of nasal antiseptic cream is the best method of obtaining haemostasis.
Search Strategy:
Medline 1966-12/00 using the OVID interface.
Search Details:
{(exp epistaxis OR epistaxis.mp OR nosebleed$.mp) OR [(exp hemorrhage OR hemorrhage.mp OR haemorrhage.mp OR bleed$.mp) AND (exp nose OR nose.mp OR exp nasal mucosa OR nasal mucosa.mp OR nasal.mp OR nares.mp)]} AND (exp cautery OR cauter$.mp OR exp silver nitrate OR nasal cautery.mp OR exp anti-infective agents OR anti-infective agents.mp) LIMIT to human AND english.
Outcome:
Altogether 198 papers found of which 196 were irrelevant or of insufficient quality. The remaining two papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Management of epistaxis in children. Ruddy J, Proops DW, Pearman K, et al. 1991, UK | 48 consecutive children with anterior epistaxis attending an emergency department. Antiseptic nasal carrier cream (Naseptin) vs silver nitrate cautery |
PRCT | Recurrent epistaxis rate | 50% vs 46% (no significant difference) | Low power |
| A randomised clinical trial of antiseptic nasal carrier cream and silver nitrate cautery in the treatment of recurrent anterior epistaxis. Murthy P, Nilssen EL, Rao S, et al. 1999, UK | 64 consecutive patients with recurrent epistaxis attending an outpatients clinic Antiseptic nasal carrier cream (Naseptin) alone vs silver nitrate cautery and antiseptic cream |
PRCT | Recurrent epistaxis rate | 9% vs 11% (p=0.7569) | 14 lost to follow-up |
Author Commentary:
This BET combines two patient groups - children with primary anterior epistaxis at first presentation and children with recurrent epitaxis. The final outcome being the same - stopping any further bleeds.
Bottom Line:
Cautery and naseptin are equally effective. Given the ease of application naseptin is the treatment of choice.
References:
- Ruddy J, Proops DW, Pearman K, et al.. Management of epistaxis in children.
- Murthy P, Nilssen EL, Rao S, et al.. A randomised clinical trial of antiseptic nasal carrier cream and silver nitrate cautery in the treatment of recurrent anterior epistaxis.