Christine M Clark1, Jane R Schubart2, Michele M Carr3. 1. Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington DC, USA. 2. Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA. 3. Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV 26501, USA. Electronic address: mmc0040@hsc.wvu.edu.
Abstract
OBJECTIVE: To define current practices in management of secondary post-tonsillectomy hemorrhage (PTH) in children by pediatric and general otolaryngologists. INTRODUCTION: Bleeding after tonsillectomy is common. Our goal was to describe management methods across the U.S. METHODS: Questions regarding perioperative management and treatment in response to three hypothetical cases featuring secondary post-tonsillectomy bleeding were posed via REDCap survey. Comparisons were made for pediatric otolaryngology fellowship training, regions of residency training and current practice, practice type, and number of years in practice. RESULTS: A total of 400 surveys were distributed with 104 responses. Fellowship-trained respondents were more likely to have been in practice for less than ten years (41.5% versus 17.8%) and to practice in an academic setting (67.3% versus 13.6%). They were less likely to prescribe antibiotics after tonsillectomy and more likely to prescribe acetaminophen (98.3% versus 80.4%), ibuprofen (79.3% versus 56.5%), and narcotics (74.1% versus 50.0%) compared to general otolaryngologists. When faced with a post-tonsillectomy patient with visible clot but no active bleeding, pediatric otolaryngologists were less likely to remove the clot (31.6% versus 54.3%) and more likely to proceed to the OR (75.9% versus 56.5%) and admit the patient (87.9% versus 68.9%). Few regional differences were encountered; however, factors influencing the decision to pursue operative intervention varied by region. CONCLUSION: Pediatric otolaryngologists are more likely to follow American Academy of Otolaryngology guidelines for tonsillectomy perioperative management. They also manage patients with secondary PTH differently than general otolaryngologists. Management trends are similar by region but salient factors considered in the decision-making process vary.
OBJECTIVE: To define current practices in management of secondary post-tonsillectomy hemorrhage (PTH) in children by pediatric and general otolaryngologists. INTRODUCTION:Bleeding after tonsillectomy is common. Our goal was to describe management methods across the U.S. METHODS: Questions regarding perioperative management and treatment in response to three hypothetical cases featuring secondary post-tonsillectomy bleeding were posed via REDCap survey. Comparisons were made for pediatric otolaryngology fellowship training, regions of residency training and current practice, practice type, and number of years in practice. RESULTS: A total of 400 surveys were distributed with 104 responses. Fellowship-trained respondents were more likely to have been in practice for less than ten years (41.5% versus 17.8%) and to practice in an academic setting (67.3% versus 13.6%). They were less likely to prescribe antibiotics after tonsillectomy and more likely to prescribe acetaminophen (98.3% versus 80.4%), ibuprofen (79.3% versus 56.5%), and narcotics (74.1% versus 50.0%) compared to general otolaryngologists. When faced with a post-tonsillectomy patient with visible clot but no active bleeding, pediatric otolaryngologists were less likely to remove the clot (31.6% versus 54.3%) and more likely to proceed to the OR (75.9% versus 56.5%) and admit the patient (87.9% versus 68.9%). Few regional differences were encountered; however, factors influencing the decision to pursue operative intervention varied by region. CONCLUSION: Pediatric otolaryngologists are more likely to follow American Academy of Otolaryngology guidelines for tonsillectomy perioperative management. They also manage patients with secondary PTH differently than general otolaryngologists. Management trends are similar by region but salient factors considered in the decision-making process vary.
Authors: Bin Xu; Hai-Yan Jin; Ke Wu; Cao Chen; Li Li; Yang Zhang; Wei-Zhong Gu; Chao Chen Journal: World J Clin Cases Date: 2021-03-06 Impact factor: 1.337
Authors: David Slouka; Štěpánka Čejková; Jana Hanáková; Petr Hrabačka; Stanislav Kormunda; David Kalfeřt; Alena Skálová; Václav Šimánek; Radek Kucera Journal: Int J Environ Res Public Health Date: 2021-02-17 Impact factor: 3.390