Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-23T01:18:53.522Z Has data issue: false hasContentIssue false
  • English
  • Français

The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis

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

Abstract

Objective:

Epistaxis is a common ENT emergency in the UK; however, despite the high incidence, there are currently no nationally accepted guidelines for its management. This paper seeks to recommend evidence-based best practice for the hospital management of epistaxis in adults.

Methods:

Recommendations were developed using an Appraisal of Guidelines for Research and Evaluation (‘AGREE II’) framework. A multifaceted systematic review of the relevant literature was performed and a multidisciplinary consensus event held. Management recommendations were generated that linked the level of supporting evidence and a Grading of Recommendations Assessment, Development and Evaluation (‘GRADE’) score explaining the strength of recommendation.

Recommendations:

Despite a paucity of high-level evidence, management recommendations were formed across five management domains (initial assessment, cautery, intranasal agents, haematological factors, and surgery and radiological intervention).

Conclusion:

These consensus recommendations combine a wide-ranging review of the relevant literature with established and rigorous methods of guideline generation. Given the lack of high-level evidence supporting the recommendations, an element of caution should be used when implementing these findings.

Keywords

EpistaxisAssessmentCauteryPackingHematologySurgery
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 12 , December 2017 , pp. 1142 - 1156
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

1NHS Hospital Episode Statistics in England and Wales. In: http://www.hesonline.nhs.uk [16 June 2017]Google Scholar
2Hall, A, Blanchard, H, Chatrath, P, Hopkins, C. Epistaxis management: a multi-centre audit in England: is there a case for a national review of practice? J Laryngol Otol 2015;30:1–4Google Scholar
3Mehta, 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;131:518–22Google Scholar
4INTEGRATE (National ENT Trainee Research Network). Epistaxis 2016: national audit of management. J Laryngol Otol. In pressGoogle Scholar
5Brouwers, MC, Kho, ME, Browman, GP, Burgers, JS, Cluzeau, F, Feder, G et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 2010;182:E839–42CrossRefGoogle ScholarPubMed
6Faughnan, ME, Palda, VA, Garcia-Tsao, G, Geisthoff, UW, McDonald, J, Proctor, DD et al. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet 2011;48:73–87Google Scholar
7Fitch, K, Bernstein, SJ, Aguilar, MD, Burnand, B, LaCalle, JR. The RAND/UCLA Appropriateness Method User's Manual. Santa Monica: RAND, 2001Google Scholar
8Mcleod, 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
9Williams, 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
10Iqbal, 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
11Khan, 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
12Swords, 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
13Higgins, JP, Altman, DG, Gøtzsche, PC, Juni, P, Moher, D, Oxman, AD et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928Google Scholar
14Slim, K, Nini, E, Forestier, D, Kwiatkowski, F, Panis, Y, Chipponi, J. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 2003;73:712–16Google Scholar
15The 2011 Oxford CEBM Levels of Evidence: Introductory Document. In: http://www.cebm.net/index.aspx?o=5653 [16 June 2017]Google Scholar
16Guyatt, GH, Oxman, AD, Vist, GE, Kunz, R, Falck-Ytter, Y, Alonso-Coello, P et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6Google Scholar
17Scottish Intercollegiate Guidelines Network. Antithrombotics: Indications and Management. A National Clinical Guideline (SIGN publication no. 129). Edinburgh: SIGN, 2012Google Scholar
18Keeling, D, Baglin, T, Tait, C, Watson, H, Perry, D, Baglin, C et al. ; British Committee for Standards in Haematology. Guidelines on oral anticoagulation with warfarin - fourth edition. Br J Haematol 2011;154:311–24Google Scholar
19Hunt, BJ, Allard, S, Keeling, D, Norfolk, D, Stanworth, SJ, Pendry, K; British Committee for Standards in Haematology. A practical guideline for the haematological management of major haemorrhage. Br J Haematol 2015;170:788–803Google Scholar
20Spahn, DR, Bouillon, B, Cerny, V, Coats, TJ, Duranteau, J, Fernandez-Mondejar, E et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 2013;17:R76Google Scholar