Epistaxis Scoring System

Epistaxis Scoring System

Epistaxis Scoring System (ESS)


Katsanis E, Luke K-H, Hsu E, Li M, Lillicrap D

Scoring system

N.B.: These scores are posted with the permission of the developers.
  • Description
  • Utility
  • Administration
  • Psychometrics
  • References

The ESS assesses severity of epistaxis and can be used to identify patients who require a bleeding diasthesis workup. The target population is children with epistaxis.

Contact person:
E Katsanis: [email protected]

Date of this review: August 26, 2013
Updated: April, 2014

Overall utility:

Useful in the pediatric clinical setting of epistaxis only for assessing which children should have further investigations.


  • Expert administered
  • Although one study did show little validity in differentiating children with a coagulopathy vs. without, it is important to note that that study, unlike the initial study, was retrospective and no specific definition of recurrent epistaxis for patient inclusion was recorded.

1.  Time to complete: Not documented, but very few questions therefore likely short

2.  Equipment/space required: None

3.  Training required: Expert-administered; no training specific to the administration of the scoring tool is required

4.  Cost: None

5.  Scoring/scaling/interpretation of results:

  • Scale 0–2 for each of 5 epistaxis bleeding symptoms
  • Possible range of total score 0–10
  • Abnormal bleeding score (BS) (or severe epistaxis) ≥7

Psychometric properties:

1.  Construct validity:

Convergent validity

  • Only children with an abnormal bleeding score (BS) had a history of needing cautery.1
  • Abnormal BS was associated with increased prevalence of anemia.1
  • Bleeding time was more likely to be prolonged in those with an abnormal BS.1

Group differences

  • Family history of a bleeding diathesis was more likely in those with severe epistaxis than mild.1
  • All children with a bleeding history (other than epistaxis) had an abnormal BS, whereas no child with mild epistaxis (normal BS) had other bleeding1
  • A second study showed no difference in BS in children with recurrent epistaxis and coagulopathy vs. no coagulopathy.2

2.  Criterion validity: The two patients with VWD in the initial study were identified as having an abnormal BS.1

3.  Reliability: No studies identified

4.  Responsiveness/sensitivity: No studies identified

Languages studied: English

Groups tested with this measure: Children with epistaxis1,2

Age: Children only

  1. Katsanis E et al. Prevalence and significance of mild bleeding disorders in children with recurrent epistaxis. J Pediatr 1988; 113: 73-76.
  2. Sandoval C et al. Clinical and laboratory features of 178 children with recurrent epistaxis. J Pediatr Hematol Oncol 2002; 24: 47-49.