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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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References

1 Integrate (National ENT Trainee Research Network). Epistaxis 2016: national audit of management. J Laryngol Otol. In pressGoogle Scholar
2 Mcleod, RW, Price, A, Williams, RJ, Smith, ME, Smith, M, Owens, D. Intranasal cautery for the management of adult epistaxis: systematic review. J Laryngol Otol. In pressGoogle Scholar
3 Williams, A, Biffen, A, Pilkington, N, Arrick, L, Williams, RJ, Smith, ME et al. Haematological factors in the management of adult epistaxis: systematic review. J Laryngol Otol. In pressGoogle Scholar
4 Iqbal, I, Jones, HG, Dawe, N, Mamais, C, Smith, ME, Williams, RJ et al. Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review. J Laryngol Otol. In pressGoogle Scholar
5 Swords, C, Patel, A, Smith, ME, Williams, RJ, Kuhn, I, Hopkins, C. Surgical and interventional radiological management of adult epistaxis: systematic review. J Laryngol Otol. In pressGoogle Scholar
6 Higgins, JP, Altman, DG, Gøtzsche, PC, Jüni, P, Moher, D, Oxman, AD et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928 CrossRefGoogle ScholarPubMed
7 Slim, K, Nini, E, Forestier, D, Kwiatkowski, F, Panis, Y, Chipponi, J. Methodological index for non-randomised studies (MINORS): development and validation of a new instrument. ANZ J Surg 2003;73:712–16CrossRefGoogle Scholar
8 Kristensen, VG, Nielsen, AL, Gaihede, M, Boll, B, Delmar, C. Mobilisation of epistaxis patients – a prospective, randomised study documenting a safe patient care regime. J Clin Nurs 2011;20:1598–605Google Scholar
9 Beran, M, Petruson, B. Occurrence of epistaxis in habitual nose-bleeders and analysis of some etiological factors. ORL J Otorhinolaryngol Relat Spec 1986;48:297–303 Google Scholar
10 García Callejo, FJ, Bécares, Martínez C, Calvo, González J, Martínez, Beneyto P, Marco, Sanz M, Marco, Algarra J. Epistaxis and dabigatran, a new non-vitamin K antagonist oral anticoagulant. Acta Otorrinolaringol Esp 2014;65:346–54Google Scholar
11 Denholm, SW, Maynard, CA, Watson, HG. Warfarin and epistaxis – a case controlled study. J Laryngol Otol 1993;107:195–6Google Scholar
12 Herkner, H, Laggner, AN, Müllner, M, Formanek, M, Bur, A, Gamper, G et al. Hypertension in patients presenting with epistaxis. Ann Emerg Med 2000;35:126–30Google Scholar
13 Smith, J, Siddiq, S, Dyer, C, Rainsbury, J, Kim, D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol 2011;125:38–42 Google Scholar
14 Abrich, V, Brozek, A, Boyle, TR, Chyou, PH, Yale, SH. Risk factors for recurrent spontaneous epistaxis. Mayo Clin Proc 2014;89:1636–43CrossRefGoogle ScholarPubMed
15 Ando, Y, Iimura, J, Arai, S, Arai, C, Komori, M, Tsuyumu, M et al. Risk factors for recurrent epistaxis: importance of initial treatment. Auris Nasus Larynx 2014;41:41–5Google Scholar
16 Goljo, E, Dang, R, Iloreta, AM, Govindaraj, S. Cost of management in epistaxis admission: impact of patient and hospital characteristics. Laryngoscope 2015;125:2642–7Google Scholar
17 Lakhani, R, Syed, I, Qureishi, A, Bleach, N. The Wexham Criteria: defining severe epistaxis to select patients requiring sphenopalatine artery ligation. Eur Arch Otorhinolaryngol 2013;270:2039–43Google Scholar
18 Monjas-Cánovas, I, Hernández-García, I, Mauri-Barberá, J, Sanz-Romero, B, Gras-Albert, JR. Epidemiology of epistaxes admitted to a tertiary hospital. Acta Otorrinolaringol Esp 2010;61:41–7Google Scholar
19 Purkey, MR, Seeskin, Z, Chandra, R. Seasonal variation and predictors of epistaxis. Laryngoscope 2014;124:2028–33Google Scholar
20 Terakura, M, Fujisaki, R, Suda, T, Sagawa, T, Sakamoto, T. Relationship between blood pressure and persistent epistaxis at the emergency department: a retrospective study. J Am Soc Hypertens 2012;6:291–5Google Scholar
21 Klossek, JM, Dufour, X, de Montreuil, CB, Fontanel, JP, Peynègre, R, Reyt, E et al. Epistaxis and its management: an observational pilot study carried out in 23 hospital centres in France. Rhinology 2006;44:151–5Google Scholar
22 Ibrashi, F, Sabri, N, Eldawi, M, Belal, A. Effect of atherosclerosis and hypertension on arterial epistaxis. J Laryngol Otol 1978;92:877–81Google Scholar
23 Future of an Ageing Population. In: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/535187/gs-16-10-future-of-an-ageing-population.pdf [22 June 2017]Google Scholar
24 National Institute for Health and Care Excellence. Anticoagulants including non-vitamin K antagonist oral anticoagulants (NOACs). In: https://www.nice.org.uk/advice/ktt16 [22 June 2017]Google Scholar
25 New oral anticoagulants apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto). In: https://www.gov.uk/drug-safety-update/new-oral-anticoagulants-apixaban-eliquis-dabigatran-pradaxa-and-rivaroxaban-xarelto [22 June 2017]Google Scholar
26 McGarry, GW, Gatehouse, S, Hinnie, J. Relation between alcohol and nose bleeds. BMJ 1994;309:640 Google Scholar
27 McGarry, GW, Gatehouse, S, Vernham, G. Idiopathic epistaxis, haemostasis and alcohol. Clin Otolaryngol Allied Sci 1995;20:174–7Google Scholar
28 National Institute for Health and Care Excellence. Venous thromboembolism: reducing the risk for patients in hospital (Clinical Guideline CG92). In: https://www.nice.org.uk/guidance/cg92/chapter/1-recommendations [22 June 2017]Google Scholar
29 Teymoortash, A, Sesterhenn, A, Kress, R, Sapundzhiev, N, Werner, JA. Efficacy of ice packs in the management of epistaxis. Clin Otolaryngol Allied Sci 2003;28:545–7Google Scholar
30 Porter, M, Marais, J, Tolley, N. The effect of ice packs upon nasal mucosal blood flow. Acta Otolaryngol 1991;111:1122–5Google Scholar
31 Thaha, MA, Nilssen, EL, Holland, S, Love, G, White, PS. Routine coagulation screening in the management of emergency admission for epistaxis–is it necessary? J Laryngol Otol 2000;114:38–40 Google Scholar