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Risk factors for recurrent epistaxis: importance of initial treatment
Yuji Ando1, Jiro Iimura1, Satoshi Arai1
1Department of Otorhinolaryngology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan.
Objective:
A retrospective study of risk factors for recurrent epistaxis and initial treatment for refractory posterior bleeding was performed. Based on the results, proposals for appropriate initial treatment for epistaxis by otolaryngologists are presented.
Methods:
The data of 299 patients with idiopathic epistaxis treated during 2008-2009 were analyzed by multivariate logistic regression analysis. Treatment data for 101 cases of posterior bleeding were analyzed using the chi-square test.
Results:
Recurrent epistaxis occurred in 32 cases (10.7%). Unidentified bleeding point (adjusted odds ratio (OR) 5.67, 95% confidence interval (CI) 1.83-17.55, p=0.003) was predictive of an increased risk of recurrent epistaxis, and electrocautery (adjusted odds ratio (OR) 0.07, 95% confidence interval (CI) 0.03-0.17, p=0.000) was predictive of a decreased risk of recurrent epistaxis. In terms of initial treatment for posterior bleeding, the rate of recurrent epistaxis was significantly lower for patients who underwent electrocautery as initial treatment compared with those who did not (6.4% vs. 40.7%, p<0.01), and it was significantly higher for those who underwent endoscopic gauze packing compared with those who did not (39.5% vs. 15.9%, p<0.01).
Conclusion:
In the present study, the risk factors for recurrent epistaxis were unidentified bleeding point. Thus, it is important to identify and cauterize a bleeding point to prevent recurrent epistaxis. The present results also suggest the effectiveness of electrocautery and the higher rate of recurrent epistaxis for patients who underwent gauze packing as initial treatment for posterior bleeding. Electrocautery should be the first-choice treatment of otolaryngologists for all bleeding points of epistaxis, and painful gauze packing may be inadvisable for posterior bleeding. More cases of posterior bleeding are needed for future studies involving multivariate analyses and appropriate analyses of factors related to hospitalization, surgery, and embolization.
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