Retrospective study about the incidence and treatment of epistaxis in a health area in the period 2011 to 2017
Abstract Introduction and objective: Epistaxis is a frequent clinical sign and it is a usual reason for urgent consultation. We have limited data about its epidemiology and its treatment in our Region. The objectives of the study consist on: to know its incidence in our area and its epidemiological characteristics, to identify the factors associated with it and to know its different treatments. Method: An observational retrospective study that describes and analyzes all patients treated for epistaxis in the emergency department in Rafael Méndez Hospital, in Lorca (Murcia, Spain), during a period of 7 years. We studied 2.138 patients. Results: The global incidence was 1.75 cases /1,000 inhabitants per year. 96.5% were anterior epistaxis. Predominance in males, male: female ratio of 2:1. More frequent in people over 50 years old, with an average age of 54.94 years. The highest incidence was in spring and winter. 96% of the total were discharged from hospital. It is related to arterial hypertension, although without statistical significance. The most commonly used treatment was anterior nasal packing. 46% of the posterior epistaxis required surgical treatment, with a mean hospital stay of 6 days. Conclusions: Epistaxis seen in the emergency department usually has a anterior origin, affects men older than 50 years with added comorbidity, and usually resolves on an outpatient basis. Posterior epistaxis requires hospital admission and, frequently, surgical treatment.
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Arruti G, Echeverría X, Medina JJ, Mozota O, Munilla M. Tratamiento de la epistaxis. Estudio de 235 casos. Anales ORL Iber Amer. 2008; 16(5):527-41.
Bhaumik NC, Sukla B, Das B, Dey D, Nandi TK. Pattern of Epistaxis of Patients Attending in A Tertiary Care Hospital of Tripura, Northeastern Region of India. IOSR-JDMS. 2016; 15 (5):42-4.
Boettiger O. Otorrinolaringología. II Parte: Nariz, cavidades perinasales, boca, faringe, laringe. Santiago de Chile, Saval, 2000. pp 45-56.
Comelli I, Vincenti V, Benatti M, Macri G, Cervellin G, Lippi G et al. Influence of air temperature variations on incidence of epistaxis. Am J Rhinol Allergy. 2015;29(6):175-81. - https://doi.org/10.2500/ajra.2015.29.4239. - PMid:26637565
Dangol B, Shrestha N, Yadav D, Devkota I, Nepal A, Bhandari S. Epistaxis at Patan Hospital: A Retrospective Review and an Audit. Nepalese Journal of ENT Head Neck Surg. 2014; 5 (2); 26-30. - https://doi.org/10.3126/njenthns.v5i2.19424
Daniell HW. Estrogen prevention of recurrent epistaxis. Arch Otolaryngol Head Neck Surg 1995; 121:354. - https://doi.org/10.1001/archotol.1995.01890030080017. - PMid:7873156
Fishpool SJ, Tomkinson A. Patterns of hospital admission with epistaxis for 26,725 patients over an 18-year period in Wales, UK. Ann R Coll Surg Engl 2012; 94:559. - https://doi.org/10.1308/003588412X13373405386691. - PMid:23131225 PMCid:PMC3954281
Harrison A. Approach to the adult with epistaxis. In: Uptodate. Jul 26, 2017. http://www.uptodate.com/
Hijano R, Hernández A, Martínez-Arias À, Homs I, Navarrete ML. Estudio epidemiológico de las urgencias en un hospital de tercer nivel. Acta Otorrinolaringol Esp. 2009;60(1):32-37. - https://doi.org/10.1016/S0001-6519(09)70315-2 - https://doi.org/10.1016/S2173-5735(09)70095-X
Kikidis D, Tsioufis K, Papanikolaou V, Zerva K, Hantzakos A. Is epistaxis associated with arterial hypertension? A systematic review of the literature. Eur Arch Otorhinolaryngol. 2013;271(2):237-43. - https://doi.org/10.1007/s00405-013-2450-z. - PMid:23539411
Min H, Kang H, Choi G, Kim K. Association between Hypertension and Epistaxis: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2017;157(6):921-7. - https://doi.org/10.1177/0194599817721445. - PMid:28742425
Monjas-Cánovas I, Hernández-García I, Mauri-Barberá J, Sanz-Romero B, Gras-Albert JR. Epidemiología de las epistaxis ingresadas en un hospital de tercer nivel. Acta Otorrinolaringol Esp. 2010;61(1):41-7. - https://doi.org/10.1016/j.otorri.2009.09.003 - https://doi.org/10.1016/S2173-5735(10)70007-7
Moran N, Das D. Epistaxis—Incidence, Etiology, and Management: A Hospitalbased Study. Clinical Rhinology An International Journal. 2016;9(1):18-20. - https://doi.org/10.5005/jp-journals-10013-1256
Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo CA Jr. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005;46:77–81. - https://doi.org/10.1016/j.annemergmed.2004.12.014. - PMid:15988431
Paparella M, Shumrick D. Otorrinolaringología. Tomo III. Cabeza y cuello. Buenos Aires, Editorial Médica Panamericana, 1982 pp 1979-93.
Para DM, Poenaru M, Marin AH, Doros C, Stefanescu H, Balica NC. Posterior Epistaxis and Hypertension: Our ENT Department Study. Laryng Rhin Otol. 2018;97(S02):S329-S330.
Pino V, Trinidad G, González A, Pardo G, Pantoja CG, Marcos M et al. Consideraciones sobre las urgencias ORL. Análisis de 30.000 pacientes atendidos en 10 a-os. Acta Otorrinolaringol Esp. 2005;56(5):198-201. - https://doi.org/10.1016/S0001-6519(05)78600-3
Purkey M, Seeskin Z, Chandra R. Seasonal variation and predictors of epistaxis. The Laryngoscope. 2014;124(9):2028-33. - https://doi.org/10.1002/lary.24679. - PMid:24633839
Raj A, Wadhwa V, Jain A. Epidemiological Profile of ENT Emergencies: Our Experience. Indian J Otolaryngol Head Neck Surg. 2018. Disponible en: https://www.springermedizin.de/epidemiological-profile-of-ent-emergencies-our-experience/15474590. [Citado el 12 de julio de 2018].
Retuert D, Fuentealba D, Bretón A, Ricci L, Nazar R, Naser A. Manejo epistaxis posterior en hospital clinico Universidad de Chile 2013 – 2016. Rev Otorrinolaringol. Cir. Cabeza Cuello. 2017; 77 (4). Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-48162017000400389. [Citado el 12 de julio de 2018].
Sampigethya S, Cherian E, Pratap D, Mani I, Bhat VS. A clinical study of epistaxis. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2018; 4 (2):555-8. - https://doi.org/10.18203/issn.2454-5929.ijohns20180724
Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med 2009; 360:784. - https://doi.org/10.1056/NEJMcp0807078. - PMid:19228621
Soto-Galindo GA, Trevi-o JL. Epistaxis diagnosis and treatment update: A review. Ann Otolaryngol Rhinol. 2017;4(4):1176.
Vaamonde P, Martín C, Cajade J, Mínguez I, Lechuga R, Frade C et al. Datos epidemiológicos sobre la epistaxis: estudio hospitalario y revisión de la literatura. Acta Otorrinolaringológica Gallega. 2003; 4:1-8.
Villwock JA, Jones K. Recent trends in epistaxis management in the United States: 2008-2010. JAMA Otolaryngol Head Neck Surg 2013; 139:1279. - https://doi.org/10.1001/jamaoto.2013.5220. - PMid:24136624
Walker T, Macfarlane T, McGarry G. The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions 1995-2004. Clin Otolaryngol. 2007;32(5):361-5. - https://doi.org/10.1111/j.1749-4486.2007.01530.x. - PMid:17883556
Alvi A, Joyner-Triplett N. Acute epistaxis. How to spot the source and stop the flow. Postgrad Med 1996;99:83. - https://doi.org/10.1080/00325481.1996.11946118
Arruti G, Echeverría X, Medina JJ, Mozota O, Munilla M. Tratamiento de la epistaxis. Estudio de 235 casos. Anales ORL Iber Amer. 2008; 16(5):527-41.
Bhaumik NC, Sukla B, Das B, Dey D, Nandi TK. Pattern of Epistaxis of Patients Attending in A Tertiary Care Hospital of Tripura, Northeastern Region of India. IOSR-JDMS. 2016; 15 (5):42-4.
Boettiger O. Otorrinolaringología. II Parte: Nariz, cavidades perinasales, boca, faringe, laringe. Santiago de Chile, Saval, 2000. pp 45-56.
Comelli I, Vincenti V, Benatti M, Macri G, Cervellin G, Lippi G et al. Influence of air temperature variations on incidence of epistaxis. Am J Rhinol Allergy. 2015;29(6):175-81. - https://doi.org/10.2500/ajra.2015.29.4239. - PMid:26637565
Dangol B, Shrestha N, Yadav D, Devkota I, Nepal A, Bhandari S. Epistaxis at Patan Hospital: A Retrospective Review and an Audit. Nepalese Journal of ENT Head Neck Surg. 2014; 5 (2); 26-30. - https://doi.org/10.3126/njenthns.v5i2.19424
Daniell HW. Estrogen prevention of recurrent epistaxis. Arch Otolaryngol Head Neck Surg 1995; 121:354. - https://doi.org/10.1001/archotol.1995.01890030080017. - PMid:7873156
Fishpool SJ, Tomkinson A. Patterns of hospital admission with epistaxis for 26,725 patients over an 18-year period in Wales, UK. Ann R Coll Surg Engl 2012; 94:559. - https://doi.org/10.1308/003588412X13373405386691. - PMid:23131225 PMCid:PMC3954281
Harrison A. Approach to the adult with epistaxis. In: Uptodate. Jul 26, 2017. http://www.uptodate.com/
Hijano R, Hernández A, Martínez-Arias À, Homs I, Navarrete ML. Estudio epidemiológico de las urgencias en un hospital de tercer nivel. Acta Otorrinolaringol Esp. 2009;60(1):32-37. - https://doi.org/10.1016/S0001-6519(09)70315-2 - https://doi.org/10.1016/S2173-5735(09)70095-X
Kikidis D, Tsioufis K, Papanikolaou V, Zerva K, Hantzakos A. Is epistaxis associated with arterial hypertension? A systematic review of the literature. Eur Arch Otorhinolaryngol. 2013;271(2):237-43. - https://doi.org/10.1007/s00405-013-2450-z. - PMid:23539411
Min H, Kang H, Choi G, Kim K. Association between Hypertension and Epistaxis: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2017;157(6):921-7. - https://doi.org/10.1177/0194599817721445. - PMid:28742425
Monjas-Cánovas I, Hernández-García I, Mauri-Barberá J, Sanz-Romero B, Gras-Albert JR. Epidemiología de las epistaxis ingresadas en un hospital de tercer nivel. Acta Otorrinolaringol Esp. 2010;61(1):41-7. - https://doi.org/10.1016/j.otorri.2009.09.003 - https://doi.org/10.1016/S2173-5735(10)70007-7
Moran N, Das D. Epistaxis—Incidence, Etiology, and Management: A Hospitalbased Study. Clinical Rhinology An International Journal. 2016;9(1):18-20. - https://doi.org/10.5005/jp-journals-10013-1256
Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo CA Jr. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005;46:77–81. - https://doi.org/10.1016/j.annemergmed.2004.12.014. - PMid:15988431
Paparella M, Shumrick D. Otorrinolaringología. Tomo III. Cabeza y cuello. Buenos Aires, Editorial Médica Panamericana, 1982 pp 1979-93.
Para DM, Poenaru M, Marin AH, Doros C, Stefanescu H, Balica NC. Posterior Epistaxis and Hypertension: Our ENT Department Study. Laryng Rhin Otol. 2018;97(S02):S329-S330.
Pino V, Trinidad G, González A, Pardo G, Pantoja CG, Marcos M et al. Consideraciones sobre las urgencias ORL. Análisis de 30.000 pacientes atendidos en 10 a-os. Acta Otorrinolaringol Esp. 2005;56(5):198-201. - https://doi.org/10.1016/S0001-6519(05)78600-3
Purkey M, Seeskin Z, Chandra R. Seasonal variation and predictors of epistaxis. The Laryngoscope. 2014;124(9):2028-33. - https://doi.org/10.1002/lary.24679. - PMid:24633839
Raj A, Wadhwa V, Jain A. Epidemiological Profile of ENT Emergencies: Our Experience. Indian J Otolaryngol Head Neck Surg. 2018. Disponible en: https://www.springermedizin.de/epidemiological-profile-of-ent-emergencies-our-experience/15474590. [Citado el 12 de julio de 2018].
Retuert D, Fuentealba D, Bretón A, Ricci L, Nazar R, Naser A. Manejo epistaxis posterior en hospital clinico Universidad de Chile 2013 – 2016. Rev Otorrinolaringol. Cir. Cabeza Cuello. 2017; 77 (4). Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0718-48162017000400389. [Citado el 12 de julio de 2018].
Sampigethya S, Cherian E, Pratap D, Mani I, Bhat VS. A clinical study of epistaxis. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2018; 4 (2):555-8. - https://doi.org/10.18203/issn.2454-5929.ijohns20180724
Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med 2009; 360:784. - https://doi.org/10.1056/NEJMcp0807078. - PMid:19228621
Soto-Galindo GA, Trevi-o JL. Epistaxis diagnosis and treatment update: A review. Ann Otolaryngol Rhinol. 2017;4(4):1176.
Vaamonde P, Martín C, Cajade J, Mínguez I, Lechuga R, Frade C et al. Datos epidemiológicos sobre la epistaxis: estudio hospitalario y revisión de la literatura. Acta Otorrinolaringológica Gallega. 2003; 4:1-8.
Villwock JA, Jones K. Recent trends in epistaxis management in the United States: 2008-2010. JAMA Otolaryngol Head Neck Surg 2013; 139:1279. - https://doi.org/10.1001/jamaoto.2013.5220. - PMid:24136624
Walker T, Macfarlane T, McGarry G. The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions 1995-2004. Clin Otolaryngol. 2007;32(5):361-5. - https://doi.org/10.1111/j.1749-4486.2007.01530.x. - PMid:17883556
Hellín-Valiente, E., Merino-Gálvez, E., & Hellín-Meseguer, D. (2019). Retrospective study about the incidence and treatment of epistaxis in a health area in the period 2011 to 2017. Revista ORL, 10(1), 45–56. https://doi.org/10.14201/orl.18642
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