Relationship between blood pressure and persistent epistaxis at the emergency department: a retrospective study

Terakura, Moriyuki; Fujisaki, Ryuichi; Suda, Takaoki; Sagawa, Toshio; Sakamoto, Tetsuya

doi:10.1016/j.jash.2012.05.001

Cited by 28 publications

(40 citation statements)

References 11 publications

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“…While both high blood pressure 25–27 and low blood pressure 28–30 have been associated with poor outcomes, we found patients with systolic blood pressure ≤ 97 mmHg to have at least twice the odds of experiencing an admission after discharge‥ We also found that for the standard cut off ranges, a systolic blood pressure < 90 bpm has close to 3.5 times the odds of admission after discharge, the highest odds of all vital signs. This finding is consistent with clinical judgement.…”

Section: Discussionmentioning

confidence: 52%

Emergency Department Vital Signs and Outcomes After Discharge

Gabayan

Gould

Weiss

et al. 2017

Academic Emergency Medicine

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Objective Vital signs are critical markers of illness severity in the Emergency Department (ED). Providers need to understand the abnormal vital signs in older adults that are problematic. We hypothesized that in patients age ≥ 65 years discharged from the ED, there are abnormal vital signs that are associated with an admission to an inpatient bed within 7 days of discharge. Methods We conducted a retrospective cohort study using data from a regional integrated health system of members age ≥ 65 years during the years 2009–2010. We used univariate contingency tables to assess the relationship between hospital admission within 7 days of discharge and vital sign (including systolic blood pressure, heart rate, body temperature, and pulse oximetry (Sp02) values measured closest to discharge) using standard thresholds for abnormal and thresholds derived from the study data‥ Results Of 104,025 ED discharges, 4,638 (4.5%) were followed by inpatient admission within 7-days. Vital signs had a greater odds of admission beyond a single cut-off. The vital signs with at least twice the odds of admission were systolic blood pressure ≤ 97 mmHg (OR 2.02, 95% CI 1.57–2.60), heart rate ≥ 101 bpm (OR 2.00 95% CI 1.75–2.29), body temperature ≥99.2 degrees Fahrenheit (OR 2.14, 95% CI 1.90–2.41), and pulse oximetry ≤ 92 Sp02 (OR 2.04, 95% CI 1.55–2.68). Patients with two vital sign abnormalities per the analysis had the highest odds of admission. A majority of patients discharged with abnormal vital signs per the analysis were not admitted within 7 days of ED discharge. Conclusion While we found a majority of patients discharged with abnormal vital signs as defined by the analysis, not to be admitted after discharge, we identified vital signs associated with at least twice the odds of admission.

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Section: Discussionmentioning

confidence: 52%

Emergency Department Vital Signs and Outcomes After Discharge

Gabayan

Gould

Weiss

et al. 2017

Academic Emergency Medicine

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“…In a systematic review of literature, Kikids and colleagues observed that arterial hypertension was higher in patients at the time of epistaxis when compared with the general population, most of the studies they reviewed agreed that there was a cross correlation between epistaxis and arterial hypertension, and they further suggested that epistaxis may lead to the diagnosis of a previously unrecognized arterial hypertension, they however could not find a causal relationship between epistaxis and arterial hypertension [20]. In an analysis of 133 patients with epistaxis by Terakura and colleagues, systolic blood pressure was found to be statistically significantly higher in patients with epistaxis, and on further multivariate analysis, systolic blood pressure was found to be an independent factor associated with epistaxis recurrence [21].…”

Section: Discussionmentioning

confidence: 98%

“…The association between epistaxis and hypertension is still being debated. Some authors belief that hypertension is common in acute epistaxis because of cofounding stress, and possible white coat phenomenon, but believe that a causation between epistaxis and hypertension is difficult to establish, while others believe that elevated blood pressure is a cause of epistaxis [18][19][20][21][22]. In a systematic review of literature, Kikids and colleagues observed that arterial hypertension was higher in patients at the time of epistaxis when compared with the general population, most of the studies they reviewed agreed that there was a cross correlation between epistaxis and arterial hypertension, and they further suggested that epistaxis may lead to the diagnosis of a previously unrecognized arterial hypertension, they however could not find a causal relationship between epistaxis and arterial hypertension [20].…”

Section: Discussionmentioning

confidence: 99%

Clinical Profile of Epistaxis in Sokoto: A 12-Year Analysis

Daniel¹,

Stephen²

2019

IJO

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Epistaxis is bleeding from the Nose and Paranasal sinuses and could be a life threatening emergency requiring urgent attention. The aim is to determine the aetiological factors and highlight treatment modalities in a tertiary hospital in Northwestern Nigeria. This was a 12-year retrospective study of all patients managed with epistaxis between January 2000 and December 2011in the otorhinolaryngology department of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Ninetyfive patients were reviewed, out of which 61 [64%] were males and 34 [36%] were females. Age group 20-29 years had the highest prevalence [21.1%]. The commonest aetiology was hypertension in 24.2% of patients followed by idiopathic 21.1%, rhinosinusitis 20%, trauma 14.7%. Anterior nasal packing was the most common method of treatment [49.5%]. Epistaxis is a common Otorhinolaryngological condition. Hypertension was the commonest cause in this study, with most cases seen in patients' aged 20-29years.

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“…It was repeatedly described not to increase the risk for epistaxis or its severity. 3,16 Acute hypertension during a nosebleed is a proposed 17 and intuitively apparent cause for a refractory epistaxis. Nevertheless, was acute hypertension counter-intuitively not a risk factor for severe epistaxis in our own analysis of almost 600 emergency events.…”

Section: Discussionmentioning

confidence: 99%

The long-term fate of epistaxis patients with exposure to antithrombotic medication

Stadler

Kindler

Holzmann

et al. 2016

Eur Arch Otorhinolaryngol

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The goal of this study was to evaluate independent risk factors for long-term epistaxis recurrences and their severity. Individual retrospective cohort study-2b level of evidence. The medical information of 603 emergency epistaxis patients was acquired during a former study. This cohort has been contacted 6 years later by conventional mail and asked to answer a specific paper questionnaire. The following parameters were evaluated: recurrent epistaxis episodes, need for a surgical intervention to stop the recurrent bleeding, patient's history for hypertension and diabetes, intake of hemostasis impairing medication now and in the past. One hundred and six (106) patients were included in the study (35.8 % response rate). The mean observation period was 76.58 months. Almost half of the patients (41.5 % = 44/106) reported at least one recurrent epistaxis episode. Patients with exposure to VKA (vitamin K antagonists) showed significantly more frequently a recurrent epistaxis episode. The binary logistic regression confirmed the intake of VKA as an independent and significant risk factor with an odds ratio of 11.6. Every single patient who had to undergo a surgical intervention to stop a recurrent bleeding stated ASA (Acetylsalicylic Acid) intake. We provide evidence that the intake of a vitamin K antagonist is an independent long-term risk factor for recurrent epistaxis episodes. The intake of ASA is a risk factor for the severity of recurrent epistaxis with the increased need for a surgical intervention not only in a short-but also in a long-term perspective. Level of evidence: This prognostic investigation, designed as a combined prospective and retrospective cohort study, reaches level 2b level of evidence as it includes retrospective aspects. Objectives/Hypothesis 7The goal of this study was to evaluate independent risk factors for long-term epistaxis 8 recurrences and their severity. 9 Study design 10Individual retrospective cohort study -2b level of evidence. 11 Methods 12The medical information of 603 emergency epistaxis patients was acquired during a 13 former study. This cohort has been contacted six years later by conventional mail 14 and asked to answer a specific paper-questionnaire. The following parameters were 15 evaluated: Recurrent epistaxis episodes, need for a surgical intervention in order to 16 stop the recurrent bleeding, patient's history for hypertension and diabetes, intake of 17 hemostasis impairing medication now and in the past. 18 Results 19One hundred and six (106) VKA as an independent and significant risk factor with an odds ratio of 11.6. Every 25 single patient who had to undergo a surgical intervention in order to stop a recurrent 26 bleeding stated ASA (Acetylsalicylic Acid) intake. 27 2 Conclusion 28We provide evidence that the intake of a vitamin K antagonist is an independent 29 long-term risk factor for recurrent epistaxis episodes. 30The intake of ASA is a risk factor for the severity of recurrent epistaxis with the 31 increased need for a surgical intervention not ...

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Relationship between blood pressure and persistent epistaxis at the emergency department: a retrospective study

Cited by 28 publications

References 11 publications

Emergency Department Vital Signs and Outcomes After Discharge

Emergency Department Vital Signs and Outcomes After Discharge

Clinical Profile of Epistaxis in Sokoto: A 12-Year Analysis

The long-term fate of epistaxis patients with exposure to antithrombotic medication

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