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Original Investigation |

Recent Trends in Epistaxis Management in the United States:  2008-2010

Jennifer A. Villwock, MD1; Kristin Jones, MD1
[+] Author Affiliations
1Department of Otolaryngology, State University of New York–Upstate Medical University, Syracuse
JAMA Otolaryngol Head Neck Surg. 2013;139(12):1279-1284. doi:10.1001/jamaoto.2013.5220.
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Importance  The treatment of epistaxis is variable. It is important to analyze the effect of the available interventions on patient outcomes.

Objective  To determine demographic, management, and outcome trends in patients admitted with a primary diagnosis of epistaxis and treated with conservative management, nasal packing, arterial ligation, or embolization.

Design, Setting, and Participants  A review of the data reported by hospitals to the 2008-2010 Nationwide Inpatient Sample for patients admitted with a primary diagnosis of epistaxis was conducted.

Interventions  Conservative management, nasal packing, arterial ligation, or embolization for epistaxis control.

Main Outcomes and Measures  Descriptive statistics for hospital and patient demographic data. Multivariate models were constructed to compare treatment modalities, controlling for patient- and hospital-level variation while reporting the treatment outcomes of mortality, stroke, blindness, length of stay, and total cost. Comparisons were made between patients undergoing embolization, surgical ligation, or nasal packing. Descriptive statistics for patients treated conservatively are reported.

Results  A total of 57 039 cases of primary epistaxis were identified. Of these, 21 872 patients (38.3%) were treated conservatively, 30 389 (53.3%) received nasal packing or cauterization, 2706 (4.7%) underwent arterial ligation, and 1956 (3.4%) underwent embolization The odds of stroke in patients following embolization were significantly higher than in patients who underwent nasal packing (odds ratio, 4.660; P = .003), with no significant difference seen compared with surgical ligation (P = .70). There were no significant differences in the odds of mortality or blindness between any of the study groups. Patients undergoing embolization incurred the highest total hospital costs, nearly doubling the cost of ligation (P < .001), without a corresponding increase in the length of hospital stay (P = .20).

Conclusions and Relevance  Treatment for epistaxis is highly variable. No significant differences in clinical outcomes were noted between arterial ligation and embolization in the population studied, although embolization resulted in significantly higher costs. Further prospective studies are needed to elucidate variables affecting outcomes of the various treatment options for epistaxis.

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