소아코피

The impact of atmospheric concentration of particulate matter ≤10 μm in diameter (PM10) continues to attract research attention. This study aimed to evaluate the effects of meteorological factors, including PM10 concentration, on epistaxis presentation in children and adults. We reviewed the data from 1557 days and 2273 cases of epistaxis between January 2015 and December 2019. Eligible patients were stratified by age into the children (age ≤17 years) and adult groups. The main outcome was the incidence and cumulative number of epistaxis presentations in hospital per day and month. Meteorological factors and PM10 concentration data were obtained from the Korea Meteorological Administration. Several meteorological factors were associated with epistaxis presentation in hospital; however, these associations differed between children and adults. Only PM10 concentration was consistently associated with daily epistaxis presentation in hospital among both children and adults. Additionally, PM10 concentration was associated with the daily cumulative number of epistaxis presentations in hospital in children and adults. Furthermore, the monthly mean PM10 concentration was significantly associated with the total number of epistaxis presentations in the corresponding month. PM10 concentration should be regarded as an important environmental factor that may affect epistaxis in both children and adults.

3.1. Characteristics of the Enrolled Subjects: We reviewed the medical records from 1704 days. A total of 2249 cases were approached, and 692 cases were excluded because they were thought to be secondary epistaxis cases; finally, 1557 cases of epistaxis were identified. The mean age of the patients was 44.94 (SD: 25; range: 1–94) years (Table 1). Among them, 20.7% (323/1557) were children, and 79.3% (1234/1557) were adults. The mean age of the children was 7.59 (SD: 4.41; range: 1–17) years, and that of the adults was 60.00 (SD 18.85; range: 18–94) years (Table 1). Meteorological factors such as cloud cover, humidity, temperature, air pressure, solar radiation, sunshine duration, wind speed, and PM10 concentration were evaluated as exposure variables (Supplementary Table S1).

3.2. Monthly Distribution of Meteorological Factors and PM10 Concentration: The coldest month of the year was January, with a mean daily temperature of −2.14 °C, followed by February (0.05 °C) and December (0.33 °C) (Figure 1A). The hottest month was August, with a mean daily temperature of 27.49 °C, followed by July (26.95 °C) and June (23.32 °C). The lowest monthly mean relative humidity was observed in March (50.67%), followed by February (51.13%) and January (51.50%) (Figure 1B). The monthly mean relative humidity was highest in July (69.61%) and August (66.61%). The highest mean wind speed was evident in February (2.41 m/s), followed by March (2.38 m/s) (Figure 1A). The highest mean air pressure was observed in December (10,150 hPa) (Figure 1A). The month with the highest duration of sunshine and greatest amount of solar radiation was May (9.28 h, 20.31 MJ/m2) (Figure 1A). The number of clouds was highest in July (6.46 [1/10]) and lowest in January (3.74 [1/10]) (Figure 1A). The mean concentration of PM10 was highest in March (58.66 μg/m3), followed by February (55.34 μg/m3) and January (51.38 μg/m3) (Figure 1B). When we reviewed the number of epistaxis cases, we observed that the children and adults showed different patterns. The adult group had the highest number of patients during the winter months, whereas the children group had the highest number of cases during the summer months (Figure 2 and Supplementary Figure S1). We further classified the age of the adult group into three subdivisions, “18–39 years”, “40–69 years”, and “>70 years”. All age groups among the adults showed a similar pattern of lesser number of epistaxis cases during the summer months (Supplementary Figure S2).

3.3. Factors Associated with the Incidence of Epistaxis Presentation in Hospital per Day among Children and Adults: The associations between meteorological factors, including PM10 concentration, and epistaxis presentation in hospital were evaluated using multivariate logistic regression analysis (Table 2). Among children, mean temperature, mean wind speed, sunshine duration, and PM10 concentration were positively associated with the incidence of epistaxis presentation in hospital. Among adults, the number of clouds and PM10 concentration were positively associated with the incidence of epistaxis presentation in hospital, whereas minimum temperature and mean relative humidity were negatively associated with the incidence of epistaxis presentation in hospital (Table 2).

To check the linearity assumption, we visualized the relationship between the logit value of the predicted probability and the statistically significant exposure variables (Supplementary Figure S3). We observed a particularly strong linear relationship with temperature and PM10 concentration using predicted logit probability (Supplementary Figure S3).

3.4. Factors Associated with the Number of Epistaxis Presentations in Hospital per Day among Children and Adults: We evaluated the impact of meteorological factors, including PM10 concentration, on the cumulative number of epistaxis presentations in hospital per day using ordinal regression analysis (Table 3). Increased mean temperature, mean wind speed, sunshine duration, and PM10 concentration were associated with an increase in the daily number of epistaxis cases among children. In adults, increased PM10 concentration was associated with an increase in the daily number of epistaxis cases, whereas increased maximum temperature, maximum wind speed, and mean relative humidity were associated with fewer cases.

3.5. Additive Effect of PM10 Concentration on Epistaxis Presentation in Hospital: To evaluate the additive effects of PM10 concentration, we calculated the mean PM10 concentration per month and examined those against the total number of epistaxis presentations in hospital within the same month (Figure 3). We observed that the monthly mean PM10 concentration was positively (Pearson’s coefficient = 0.884, p < 0.001) associated with the total number of epistaxis presentations in hospital within that same month.