Sentinel Bleeds: Lessons from Five Years of Management at a Tertiary Academic Center

Monday, October 13, 2025

3:06 PM - 3:12 PM EDT

Location: 127

Disclosure(s):

Ashwin R. Reddy, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Andy S. Ding, MD, MSE:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Anirudh Saraswathula, MD MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Carotid blowout syndrome (CBS), or sentinel bleed, is a rare and fatal complication of head and neck cancer (HNC). As HNC treatment shifts toward chemoradiation, trends in CBS presentation remain poorly studied. We describe the clinical characteristics of CBS over five years at a single institution.

Methods: We conducted a retrospective review of adult HNC patients presenting with oropharyngeal bleeding to the emergency department of a tertiary academic center from July 2017 to June 2022. Patient charts were abstracted for demographics, tumor characteristics, treatment history, airway and bleed management, recurrence, and mortality. Chi-square tests and univariate logistic regressions characterized differences between CBS and non-CBS patients.

Results: Among 49 patients with oropharyngeal bleeding, 13 (26.5%) met criteria for CBS. At the time of presentation, compared to non-CBS bleeding, CBS was significantly associated with oropharyngeal tumors (OR 14.3 [2.68–76.26]), tumor bed ulceration (OR 14.3 [2.68–76.26]), chemotherapy-only treatment (OR 19.8 [3.29–119.41]), need for intubation (OR 14.6 [2.42–87.73]), and need for embolization (OR 93.5 [11.75–744.33]). During hospitalization, 11 of 13 (84.6%) CBS patients underwent embolization, and only 3 of these patients (27.3%) had no further bleeding. CBS as compared to non-CBS was also associated with rebleeding after discharge (OR 8.17 [1.80–37.05]). Overall mortality was 61.5% (8/13) with a 1-year mortality rate of 53.8%. Among all CBS patients, 10 (76.9%) rebled, and 6 (46.2%) remained alive after median follow-up of 304 days.

Conclusions: In this five-year review, most CBS patients experienced rebleeding or death within one year of discharge. Standardized management algorithms may improve survival and reduce readmissions. Larger multi-institutional studies are needed to identify risk factors and optimize interventions for this life-threatening condition.

Presenting Author(s)

Ashwin R. Reddy, BS

Medical Student
The Johns Hopkins University School of Medicine
Pittsburgh, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
SJ

Sophia S. Jung, MSPH

Johns Hopkins University School of Medicine, United States

Disclosure information not submitted.

Co-Author(s)

SJ

Sophia S. Jung, MSPH

Johns Hopkins University School of Medicine, United States

Disclosure information not submitted.

Co-Author(s)

Andy S. Ding, MD, MSE

Resident Physician
The Johns Hopkins University School of Medicine
Baltimore, MD, United States

Disclosure information not submitted.

Co-Author(s)

Andy S. Ding, MD, MSE

Resident Physician
The Johns Hopkins University School of Medicine
Baltimore, MD, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Anirudh Saraswathula, MD MS

Resident Physician
Johns Hopkins University School of Medicine
Baltimore, MD, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
TQ

Tanvir Queraishi, BS

Johns Hopkins University School of Medicine, United States

Disclosure information not submitted.
JS

Jordan Smith, BS

Johns Hopkins University School of Medicine, United States

Disclosure information not submitted.
CF

Cassie Firestone, BS

Johns Hopkins University School of Medicine, United States

Disclosure information not submitted.
CL

Claudia Lee, BS

Johns Hopkins University School of Medicine, United States

Disclosure information not submitted.
Harry Quon, MD, MS

Associate Professor
Johns Hopkins University
Baltimore, Maryland, United States

Disclosure information not submitted.
JC

Justin Caplan, MD

Johns Hopkins University School of Medicine, United States

Disclosure information not submitted.
ZK

Zubair Khan, MBBS

Johns Hopkins University School of Medicine, United States

Disclosure information not submitted.

Senior Author(s)

CF

Carole Fakhry, MD MPH

Professor
Johns Hopkins Univ
Baltimore, Maryland, United States

Disclosure information not submitted.