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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)*
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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 

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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