International Practice Variation in Post‐Tonsillectomy Hemorrhage: A Survey Study of Pediatric Otolaryngologists
Bibliographic record
Abstract
Background: A significant complication of pediatric tonsillectomy is post-tonsillectomy bleeding (PTB). Management within and outside of the operating room (OR) is not standardized. We consolidated international similarities and differences in PTB management. Methods: This cross-sectional survey study was conducted from April 4 to May 16, 2024. It involved a 55-item questionnaire distributed online to a sample of pediatric otolaryngologists from 22 countries, and is a part of larger study on tonsillectomy. The study achieved a 38.2% response rate (112 of 293). Eligibility included proficiency in English and currently practicing pediatric otolaryngology. Results: A tonsil bleed was defined by 49.2% as any bleeding presenting to the hospital. In all, 58.3% signified taking patients for operative management in the presence of active bleeding. Operative criteria included persistent bleeding on presentation, repeated bleeding while admitted, severity, signs/symptoms of anemia or hemodynamic instability, or age less than 3 and non-cooperative. When treating PTB within the OR, bipolar cautery is used by 60.6%. In all, 57.3% admit all patients experiencing a PTB for 23-h observation versus 21.2% who admit a subset of patients for 23-h observation. In all, 47.7% indicated that they have a formal monitoring program for bleeding rates in their institution/practice. Readmission rates are monitored by 60.7% of respondents. Conclusion: There are no standardized best practices for PTB. Our study confirmed moderate numbers of formal monitoring programs, and varying clinical decision rules when defining a tonsil bleed, readmitting a PTB, and management within or outside of the OR. Understanding global variation may facilitate development of future clinical practice guidelines.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".