Post-tonsillectomy hemorrhage and pediatric emergency care

A cross-sectional, retrospective review of consecutive patients who presented to I of 2 pediatric emergency departments with post-tonsillectomy hemorrhage was undertaken. The study population included children who had secondary hemorrhage (bleeding at greater than 24 hours after tonsillectomy). Over a period of 2 years, 90 children received emergency care for secondary post-tonsillectomy hemorrhage. The average age was 8.5 years and there were 40 (44%) males. The average time from tonsillectomy to emergency department (ED) presentation was 7.3 days. One patient was hypotensive, and 7 had hemoglobins <10 mg/dL. Signs of bleeding on examination of the tonsillar fossa were active (4), oozing (18), clots (48), and none (14). Of the 70 children with signs of bleeding, 63 (90%) were treated surgically and 7 (10%) were observed. Four (6%) of the 63 children who had signs of bleeding and were managed surgically and 3 (43%) of the 7 children who had signs of bleeding and were managed by observation had repeat episodes of bleeding. Of the 14 patients with no signs of bleeding, all were observed and none had repeat episodes of bleeding. Signs of bleeding were not documented in 6 patients. Active hemorrhage and cardiovascular compromise were uncommon in this study population. Surgical management is recommended for children who have signs of bleeding, while observation appears to be appropriate for children who have no signs of bleeding.