An outcomes analysis of anterior epistaxis management in the emergency department

Abstract

BackgroundMany treatment options exist for the management of anterior epistaxis. However, little is known about treatment outcomes. The objective was to identify the currently utilised methods of management and outcomes for patients with anterior epistaxis presenting to the emergency department (ED) at a Canadian tertiary care center.MethodsA retrospective review of ED visits from January 2012-May 2014 for adult patients with a diagnosis of anterior epistaxis was performed. Patient demographic data, comorbidities, and treatment methods were documented. The effectiveness of different treatment modalities was determined.ResultsThree hundred fifty-three primary anterior epistaxis cases were included. Mean patient age was 70 years and 49 % of patients were female. Comorbidities included hypertension (56 %), diabetes (19 %), CAD (28 %), and atrial fibrillation (27 %). A large proportion of the cohort (61 %) was on at least one anticoagulant or antiplatelet therapy. The most common utilised treatment modalities were silver nitrate cauterization, Merocel®, petroleum gauze packing, nasal clip and 15 % were simply observed. Initial treatment success was achieved in 74 % of cases. Of patients receiving specific treatment modalities, silver nitrate cauterization had the highest success rate at 80 %. 26 % of patients returned to the ED for recurrence of epistaxis with highest rates occurring in the nasal clip (59 %), Merocel® (26 %), and petroleum gauze packing (42 %) groups.ConclusionsThe differences in recurrence rate among the different treatment modalities observed may be due to true differences in effectiveness or differences in treatment selection by the ED physicians based on severity of epistaxis. Cauterization with silver nitrate, however, offers the added benefit of no need for follow up. Further study is needed to elucidate the most efficacious treatment modality based on epistaxis severity.

Economic evaluation of floseal compared to nasal packing for the management of anterior epistaxis

“…In this present study, we followed a cohort of patients aged 70 years until they reached a life expectancy of the Canadian population of 82 years . The mean age of 70 years was consistent with that reported in a published study describing the baseline and clinical characteristics of patients with acute anterior epistaxis who visited the Ottawa Hospital . A cycle length of 1 year was used.…”

“…In a setting where healthcare funding is limited, there is growing evidence that both costs and effectiveness should be considered when choosing a modality of treatment . Although there is no particular algorithm for the treatment of epistaxis, physicians in EDs in Canada frequently use nasal packing to treat anterior epistaxis . There are a variety of different types of nasal packing, which typically have a low unit cost.…”

“…Merocel packing is a compressed, dehydrated sponge composed of hydroxylated polyvinyl acetate that can increase in size within the nasal cavity to thereby place pressure on and compress a bleeding vessel through its rehydration with normal saline. This material is one of the most commonly chosen treatments by emergency department (ED) physicians for the treatment for anterior epistaxis, and this treatment has a low unit cost …”

Epistaxis management - our point of view and literature review

“…The most commonly used chemical agent is silver nitrate, but there are also reported cases of chemical cauterization with trichloroacetic acid or chromic acid 18 . Newton et al, in a retrospective study published in April 2016, analysed the effectiveness of different anterior epistaxis treatment methods performed in the Emergency Department (silver nitrate cauterization, petroleum gauze packing, Merocel®, nasal clip or simple observation) 19 . They concluded that cauterization with silver nitrate returned best results in terms of recurrence and follow-up, compared to the Merocel® packing and petroleum gauze packing outcomes.…”

Treatment disparities in the management of epistaxis in United States emergency departments

“…Although prior studies have characterized demographic, seasonal, and geographic variation in epistaxis presentation throughout the United States, there is a limited understanding of contemporary management patterns in the ED setting . Indeed, as epistaxis management has evolved, so too has the landscape of emergency care.…”