Palavras-chave
Poluição atmosférica
Temperatura
Sazonalidade
Exposição solar
Como Citar
Resumo
Este estudo teve como objetivo sintetizar criticamente a evidência científica disponível sobre a associação entre fatores ambientais e a incidência de epistaxe em crianças. Métodos: Realizou-se uma revisão sistemática com meta-análise de estudos observacionais que avaliaram a relação entre variáveis meteorológicas ou poluentes atmosféricos e o número de casos de epistaxe pediátrica. Foram incluídos artigos publicados entre 2018 e 2024, sem restrição geográfica. Resultados: Foram analisados mais de 250.000 casos pediátricos. Identificou-se correlação positiva entre epistaxe e aumento da temperatura média, exposição solar e concentração de ozônio (O₃). Pressão atmosférica, monóxido de carbono (CO) e dióxido de enxofre (SO₂) apresentaram correlação inversa. A faixa etária e fatores como rinite alérgica e nível socioeconômico mostraram-se modificadores importantes do risco. Conclusão: A epistaxe pediátrica apresenta padrão sazonal e está associada a fatores ambientais e sociais, sendo necessária a adoção de medidas preventivas nos períodos de maior risco. Recomenda-se o desenvolvimento de políticas públicas integradas de vigilância ambiental e assistência pediátrica.
Referências
AHN, E.-J.; MIN, H. J. Age-specific associations between environmental factors and epistaxis. Frontiers in Public Health, v. 10, ID 966461, 2022.
AHN, E.-J.; MIN, H. J. Environmental factors differentially affect epistaxis among preschool and school-aged children. Frontiers in Public Health, v. 11, ID 1178531, 2023.
AKDOĞAN, M. V. et al. The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis. Ear Nose Throat Journal, v. 97, n. 9, p. E1-E5, 2018.
ALQARNI, Z. M. et al. Prevalence, causes, treatment, and outcome of epistaxis. Age, v. 60, p. 30, 2019.
BĂLĂ, G.-P. et al. Air pollution exposure—the (in) visible risk factor for respiratory diseases. Environmental Sciences and Pollution Control Series, v. 28, n. 16, p. 19615–19628, 2021.
BÉQUIGNON, E. et al. Emergency department care of childhood epistaxis. Emergency Medicine Journal, [S.l.], v. 34, n. 8, p. 543-548, 2017. DOI: https://doi.org/10.1136/emermed-2015-205528.
BRAY, D.; MONNERY, P.; TOMA, A. Airborne environmental pollutant concentration and hospital epistaxis presentation: a 5-year review. Clinical Otolaryngology & Allied Sciences, v. 29, n. 6, p. 655–658, 2004.
DAVIES, K.; BATRA, K.; MEHANNA, R.; KEOGH, I. Pediatric epistaxis: epidemiology, management and impact on quality of life. International Journal of Pediatric Otorhinolaryngology, v. 78, n. 8, p. 1294–1297, 2014.
ELALFY, M. S. et al. Epistaxis in a pediatric outpatient clinic: could it be an alarming sign? International Archives of Otorhinolaryngology, v. 26, n. 2, p. e183–e190, 2022.
EPHPP. Quality Assessment Tool for Quantitative Studies. Hamilton: The Effective Public Health Practice Project, 2010. p. 20. Disponível em: URL. Acesso em: [Data de Acesso].
GRIMM, D.; QIAN, Z. J.; YONG, M.; HWANG, P. H. The effect of PM$_{2.5}$ on acute sinusitis: a population-based study. International Forum of Allergy & Rhinology, [volume], [número], p. [páginas], 2024.
GÜNEYSU, S. T. et al. Are laboratory evaluations required in every case admitted to the pediatric emergency department with epistaxis? International Journal of Clinical Practice, [S.l.], v. 75, n. 11, e14749, 2021. DOI: https://doi.org/10.1111/ijcp.14749.
HADAR, A. et al. Pediatric epistaxis-effectiveness of conservative management. Pediatric Emergency Care, [S.l.], v. 40, n. 7, p. 551-554, 2024. DOI: https://doi.org/10.1097/PEC.0000000000003190.
KIM, J. J. et al. Relationship between meteorological factors and emergency department visits for epistaxis in Korea. Korean Journal of Otorhinolaryngology - Head and Neck Surgery, v. 57, n. 4, p. 233–238, 2014.
KIM, K.; KWAK, I.-Y.; MIN, H. Particulate matter 10 (PM10) is associated with epistaxis in children and adults. International Journal of Environmental Research and Public Health, v. 18, n. 9, ID 4809, 2021.
KIM, K.-H.; KABIR, E.; KABIR, S. A review on the human health impact of airborne particulate matter. Environment International, v. 74, p. 136–143, 2015.
KUMAR, M. I. L. I. M. et al. Seasonal variation in epistaxis in upper Assam region: a cross-sectional study. Journal of Clinical and Diagnostic Research, v. 15, n. 6, 2021.
KWAK, I.-Y.; KIM, K. S.; MIN, H. J. Differential effect of meteorological factors and particulate matter with ≤ 10-$mu$m diameter on epistaxis in younger and older children. Scientific Reports, v. 12, n. 1, ID 21029, 2022.
LEE, P.-H. et al. The impact of environmental pollutants on barrier dysfunction in respiratory disease. Allergy, Asthma & Immunology Research, v. 13, n. 6, p. 850, 2021.
LU, Y.-X. et al. Pediatric epistaxis and its correlation between air pollutants in Beijing from 2014 to 2017. Ear Nose Throat Journal, v. 99, n. 8, p. 513–517, 2020.
LUCAS, J. P. et al. Environmental impact on pediatric epistaxis and the utility of diagnostic studies: A single-institutional review. International Journal of Pediatric Otorhinolaryngology, v. 176, p. 111827, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38128356/.
MCGARR, G. W. et al. Heat strain in children during unstructured outdoor physical activity in a continental summer climate. Temperature, v. 8, n. 1, p. 80–89, 2021.
MIDDLETON, P. M. Epistaxis. Emergency Medicine Australasia, v. 16, n. 5-6, p. 428–440, 2004. Disponível em: https://pubmed.ncbi.nlm.nih.gov/15537406/.
OZONE CONCENTRATION IN THE GROUND ATMOSPHERE AND MORBIDITY DURING EXTREME HEAT IN THE SUMMER OF 2010. In: KOTELNIKOV, S.; STEPANOV, E.; IVASHKIN, V. (Eds.). Doklady Biological Sciences. [S. l.]: Springer, 2017.
PATEL, N.; MADDALOZZO, J.; BILLINGS, K. R. An update on management of pediatric epistaxis. International Journal of Pediatric Otorhinolaryngology, v. 78, n. 8, p. 1400–1404, 2014.
PURKEY, M. R.; SEESKIN, Z.; CHANDRA, R. Seasonal variation and predictors of epistaxis. Laryngoscope, v. 124, n. 9, p. 2028–2033, 2014.
SEND, T. et al. Etiology, management, and outcome of pediatric epistaxis. Pediatric Emergency Care, [S.l.], v. 37, n. 9, p. 466-470, 2021. DOI: https://doi.org/10.1097/PEC.0000000000001698.
SHAY, S.; SHAPIRO, N. L.; BHATTACHARYYA, N. Epidemiological characteristics of pediatric epistaxis presenting to the emergency department. International Journal of Pediatric Otorhinolaryngology, v. 103, p. 121–124, 2017.
SHIEH, A. et al. Risk factors and management outcomes in pediatric epistaxis at an emergency department. The Journal of Emergency Medicine, [S.l.], v. 66, n. 2, p. 97-108, 2024. DOI: https://doi.org/10.1016/j.jemermed.2023.10.031.
STOKHUIJZEN, E. et al. Severity and features of epistaxis in children with a mucocutaneous bleeding disorder. The Journal of Pediatrics, [S.l.], v. 193, p. 183-189.e2, 2018. DOI: https://doi.org/10.1016/j.jpeds.2017.09.082.
SZYSZKOWICZ, M.; SHUTT, R.; KOUSHA, T.; ROWE, B. Air pollution and emergency department visits for epistaxis. Clinical Otolaryngology, v. 39, n. 6, p. 345–351, 2014.
TUNKEL, D. E. et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngology–Head and Neck Surgery, [S.l.], v. 162, n. 1 suppl, p. S1-S38, 2020. DOI: https://doi.org/10.1177/0194599819890327.
WEI, E. X. et al. Environmental risk factors for pediatric epistaxis vary by climate zone. Laryngoscope, v. 134, n. 3, p. 1450–1456, 2024.
WIEGMAN, C. H. et al. Oxidative stress in ozone-induced chronic lung inflammation and emphysema: a facet of chronic obstructive pulmonary disease. Frontiers in Immunology, v. 11, ID 1957, 2020.
XUE, Y.; CHU, J.; LI, Y.; KONG, X. The influence of air pollution on respiratory microbiome: a link to respiratory disease. Toxicology Letters, v. 334, p. 14–20, 2020.
YU, G. et al. Is the occurrence of pediatric epistaxis related to climatic variables? International Journal of Pediatric Otorhinolaryngology, v. 113, p. 182–187, 2018.
ZEMEK, R.; SZYSZKOWICZ, M.; ROWE, B. H. Air pollution and emergency department visits for otitis media: a case-crossover study in Edmonton, Canada. Environmental Health Perspectives, v. 118, n. 11, p. 1631–1636, 2010.
ZHANG, Y. et al. The association of ambient PM$_{2.5}$ with school absence and symptoms in schoolchildren: a panel study. Pediatric Research, v. 84, n. 1, p. 28–33, 2018.
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Journal of Advanced Clinical Implementation and Applied Medical Innovations