Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-23T23:53:17.479Z Has data issue: false hasContentIssue false
  • English
  • Français

Epistaxis 2016: national audit of management

Published online by Cambridge University Press:  27 December 2017

INTEGRATE (The National ENT Trainee Research Network)
INTEGRATE (The National ENT Trainee Research Network)
Affiliation:
INTEGRATE (The National ENT Trainee Research Network)*
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Epistaxis is a common condition that can be associated with significant morbidity, and it places a considerable burden on our healthcare system. This national audit of management sought to assess current practice against newly created consensus recommendations and to expand our current evidence base.

Methods:

The management of epistaxis patients who met the inclusion criteria, at 113 registered sites across the UK, was compared with audit standards during a 30-day window. Data were further utilised for explorative analysis.

Results:

Data for 1826 cases were uploaded to the database, representing 94 per cent of all cases that met the inclusion criteria at participating sites. Sixty-two per cent of patients were successfully treated by ENT clinicians within 24 hours. The 30-day recurrent presentation rate across the dataset was 13.9 per cent. Significant event analysis revealed an all-cause 30-day mortality rate of 3.4 per cent.

Conclusion:

Audit findings demonstrate a varying alignment with consensus guidance, with explorative analysis countering some previously well-established tenets of management.

Keywords

EpistaxisSymptom AssessmentCauteryHematologySurgery
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 12 , December 2017 , pp. 1131 - 1141
Copyright
Copyright © JLO (1984) Limited 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

See Authorship and participation section for full list of collaborators.

References

1 Lowe, D, van der Meulen, J, Cromwell, D, Lewsey, J, Copley, L, Browne, J et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007;117:717–24CrossRefGoogle ScholarPubMed
2 Hopkins, C, Browne, JP, Slack, R, Lund, V, Topham, J, Reeves, B et al. The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Clin Otolaryngol 2006;31:390–8CrossRefGoogle ScholarPubMed
3 NHS Hospital Episode Statistics in England and Wales. In: http://www.hesonline.nhs.uk [16 June 2017]Google Scholar
4 Mehta, N, Williams, RJ, Smith, ME, Hall, A, Hardman, JC, Cheung, L et al. Can trainees design and deliver a national audit of epistaxis management? A pilot of a secure web-based audit tool and research trainee collaboratives. J Laryngol Otol 2017;131:518–22CrossRefGoogle Scholar
5 Integrate (National ENT Trainee Research Network). The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis. J Laryngol Otol. In pressGoogle Scholar
6 Khan, M, Conroy, K, Ubayasiri, K, Constable, J, Smith, ME, Williams, RJ et al. Initial assessment in the management of adult epistaxis: systematic review. J Laryngol Otol. In pressGoogle Scholar
7 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
8 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
9 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
10 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
11 General Medical Council. Good Medical Practice. London: GMC, 1998 Google Scholar
12 Subbe, CP, Kruger, M, Rutherford, P, Gemmel, L. Validation of a modified Early Warning Score in medical admissions. QJM 2001;94:521–6CrossRefGoogle ScholarPubMed
13 Miller, AB, Hoogstraten, B, Staquet, M, Winkler, A. Reporting results of cancer treatment. Cancer 1981;47:207–143.0.CO;2-6>CrossRefGoogle ScholarPubMed
14 Royal College of Physicians. National Hip Fracture Database (NHFD): annual report 2015. In: http://www.nhfd.co.uk/nhfd/nhfd2015reportPR1.pdf [16 June 2017]Google Scholar
15 Soyka, MB, Nikolaou, G, Rufibach, K, Holzmann, D. On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions. Rhinology 2011;49:474–8CrossRefGoogle ScholarPubMed
16 Henderson, AH, Larkins, A, Repanos, C. The use of bipolar electrocautery in adult epistaxis management: using audit of one hundred and twenty-four cases to define a standardised protocol. Clin Otolaryngol 2013;38:554–8CrossRefGoogle ScholarPubMed
17 Murer, K, Ahmad, N, Roth, BA, Holzmann, D, Soyka, MB. THREAT helps to identify epistaxis patients requiring blood transfusions. J Otolaryngol Head Neck Surg 2013;42:4 CrossRefGoogle ScholarPubMed
18 Pollice, PA, Yoder, MG. Epistaxis: a retrospective review of hospitalized patients. Otolaryngol Head Neck Surg 1997;117:49–53 CrossRefGoogle ScholarPubMed