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Outcomes analysis in epistaxis management: development of a therapeutic algorithm.
Josef Shargorodsky1, Benjamin S Bleier, Eric H Holbrook
1Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA. Josef_Shargorodsky@meei.harvard.edu
Summary
Chemical cautery is more effective for initial anterior epistaxis treatment than packing. Cautery or vascular control shortens hospital stays for patients with treatment failure.
Area of Science:
- Otolaryngology
- Emergency Medicine
- Vascular Surgery
Background:
- Epistaxis (nosebleeds) management requires effective treatment strategies.
- Optimizing epistaxis treatment can reduce patient morbidity and healthcare costs.
Purpose of the Study:
- To compare the effectiveness of different epistaxis treatment modalities.
- To inform the development of a therapeutic algorithm for epistaxis management.
Main Methods:
- Retrospective case series with chart review of 147 adult patients.
- Comparison of outcomes for cauterization, tamponade, and proximal vascular control.
- Multivariate logistic regression analysis adjusted for key patient factors.
Main Results:
- Nondissolvable packing had a higher initial treatment failure rate (57.4%) compared to cautery for anterior epistaxis.
- No significant difference in initial posterior epistaxis treatment outcomes.
- Progression to cautery or proximal vascular control after initial failure resulted in shorter inpatient stays (5.3 vs. 6.8 days).
Conclusions:
- Chemical cautery offers a higher success rate and fewer interventions for anterior epistaxis than packing.
- Packing duration does not influence epistaxis recurrence.
- Early escalation to cautery or vascular control improves outcomes for refractory epistaxis.
