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Initial assessment in the management of adult epistaxis: systematic review

Published online by Cambridge University Press:  27 December 2017

M Khan ,
K Conroy ,
K Ubayasiri ,
J Constable ,
M E Smith ,
R J Williams ,
I Kuhn ,
M Smith  and
C Philpott
M Khan*
Affiliation:
Department of Otolaryngology, Central Manchester University Hospitals, UK
K Conroy
Affiliation:
Department of Otolaryngology, University Hospitals of South Manchester, UK
K Ubayasiri
Affiliation:
Queen's Medical Centre, Nottingham, UK
J Constable
Affiliation:
Queen's Medical Centre, Nottingham, UK
M E Smith
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
R J Williams
Affiliation:
Institute of Naval Medicine, Gosport, UK
I Kuhn
Affiliation:
University of Cambridge School of Clinical Medicine, UK
M Smith
Affiliation:
Exeter Health Library, Peninsula Medical School, UK
C Philpott
Affiliation:
Norwich Medical School, University of East Anglia, UK
*
Address for correspondence: Miss Maha Khan, Department of Otolaryngology, Central Manchester University Hospitals, Peter Mount Building, Oxford Road, Manchester M13 9WL, UK E-mail: maha.khan@doctors.org.uk
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Abstract

Background:

The initial assessment of epistaxis patients commonly includes: first aid measures, observations, focused history taking, and clinical examinations and investigations. This systematic review aimed to identify evidence that informs how the initial assessment of these patients should be conducted.

Method:

A systematic review of the literature was performed using a standardised methodology and search strategy.

Results:

Seventeen articles were included. Factors identified were: co-morbidity, intrinsic patient factors, coagulation screening and ice pack use. Hypertension and anticoagulant use were demonstrated to adversely affect outcomes. Coagulation screening is useful in patients on anticoagulant medication. Four studies could not be accessed. Retrospective methodology and insufficient statistical analysis limit several studies.

Conclusion:

Sustained ambulatory hypertension, anticoagulant therapy and posterior bleeding may be associated with recurrent epistaxis, and should be recorded. Oral ice pack use may decrease severity and can be considered as first aid. Coagulation studies are appropriate for patients with a history of anticoagulant use or bleeding diatheses.

Keywords

EpistaxisComorbidityCardiovascular DiseasesHypertensionRisk FactorsFirst AidTherapy
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 12 , December 2017 , pp. 1035 - 1055
Copyright
Copyright © JLO (1984) Limited 2017 

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