Management of Epistaxis in the Emergency Room: A Comprehensive Study of Protocols and Contemporary Techniques

Abstract

Epistaxis is one of the most frequently seen otolaryngological emergencies in the emergency room (ER), and can be either a minor, self-limited anterior bleed or a more serious, posterior bleed that requires prompt treatment.  Regarding to study's background, it aims to outline the demographic profile, etiological pattern, treatment modalities, and clinical outcome of patients attending the emergency room with epistaxis and to investigate the relationship of the site of bleeding with treatment outcome statistically. A retrospective descriptive analysis was carried out in 117 patients. IBM SPSS Statistics software was used to analyse the data, which were presented as frequencies and percentages for categorical variables and as mean ± standard deviation for continuous variables, and compared by using the chi-square test and independent-samples t-test, respectively. A p-value of < 0.05 was declared as statistically significant. According to clinical outcomes, the mean age of the patients was 52.4 ± 18.6 years, with a predominance of male patients (60.7%). Idiopathic cases were the second most common (35.9%), followed by hypertension (23.9%). Anterior (76.1%) bleeding was the most frequent clinical presentation and was associated with significantly higher rates of first-attempt control as compared to posterior (95.5% vs 67.9%). The most commonly used procedure was anterior nasal packing (49.6%), with a total success rate of 88.9% of the interventions. To be concluded, idiopathic or hypertensive anterior epistaxis are most common and responded well to first-line conservative methods, whereas posterior epistaxis had significant admission rates, longer ER visit duration, and a higher need for escalation of care.