Clinical Practice Guideline: Nosebleed (Epistaxis) Executive Summary

Area of Science:

• Otolaryngology
• Emergency Medicine
• Internal Medicine

Background:

• Nosebleeds (epistaxis) are common, affecting at least 60% of the US population.
• Approximately 6% of individuals with nosebleeds seek medical attention, with epistaxis accounting for 0.5% of emergency department visits.
• Severe, persistent, or recurrent nosebleeds significantly impact patient quality of life and may require intensive interventions.

Purpose of the Study:

• To identify quality improvement opportunities in nosebleed management.
• To establish clear, actionable recommendations for clinicians treating patients with nosebleeds (≥3 years old).
• To reduce variations in care, improve health outcomes, and minimize harms associated with nosebleeds and their treatments.

Main Methods:

• Development of a multidisciplinary guideline based on evidence-based quality improvement opportunities.
• Focus on diagnosis, treatment, and prevention of nosebleeds presenting in ambulatory, emergency, and inpatient settings.
• Inclusion of first-line treatments (nasal compression, packing, cautery) and advanced procedures (arterial ligation, embolization).

Main Results:

• Recommendations include distinguishing urgent cases, using sustained nasal compression, and employing nasal packing (resorbable for specific patients).
• Guideline emphasizes anterior rhinoscopy, nasal endoscopy for recurrent bleeding, and appropriate interventions like vasoconstrictors or cautery.
• Specific guidance is provided for patients with hereditary hemorrhagic telangiectasia syndrome (HHT) and those on anticoagulation/antiplatelet medications.

Conclusions:

• Clinicians should distinguish patients needing prompt management and initiate appropriate first-line treatments.
• Nasal endoscopy and referral for advanced procedures are recommended for persistent or recurrent epistaxis.
• Patient education on prevention, home care, and seeking medical attention is crucial for managing nosebleeds effectively.