Recurrent epistaxis

Specialty: ENT
Age group: Children

Criteria for referral to public hospital service

• Recurrent epistaxis not responding to maximum medical management for more than 8 weeks (topical creams, no nose picking, allergic rhinitis management)
• Epistaxis with either
  • unilateral nasal obstruction
  • suspicion of a tumour including juvenile nasopharyngeal angiofibroma (JNA)
  • diagnosed coagulation or platelet disorder.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
• Physical examination
• Details of onset, duration, frequency, site and volume of bleeding
• The functional or psychological impact on quality of life or activities of daily living including impact on school, study, or social activities
• Details of previous management including the course of treatment(s) and outcome of treatment(s)
• Relevant medical history including bleeding disorders or use of an anticoagulant medicine
• Child’s age
• If coagulation or platelet disorder
  • full blood examination (FBE)
  • prothrombin time (PT)
  • activate partial thromboplastin time (APPT).

Provide if available

• Statement about the parent(s) or guardian’s interest in having surgical treatment if that is a possible intervention
• If the child is neurodiverse, gender diverse or has a disability
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child is from a culturally and linguistically diverse background
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If the child is aged 14-18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Epistaxis without concerning features that has resolved.