A Clinical Study of 203 Hospitalized Epistaxis Patients

Abstract

A clinical study of 203 patients with epistaxis requiring hospitalization during the past 9 years (2003-2011) is reported. Epistaxis occurred more frequently in males than in females (male:female ratio, about 2:1). The largest numbers of patients were in their 50s to 70s. Epistaxis occurred more frequently between winter and spring, and fewer patients were seen in the summer. The sites of bleeding were an unidentifiable site (47%), followed by Kiesselbach’s area (24%), inferior meatus (8%), and middle meatus (8%). Overall, 55% of patients were treated with gauze packing, 29% of patients were treated with electrical coagulation, and 8% of patients were treated with balloon tamponade initially. Re-bleeding was observed in 46% of patients. Comparing re-bleeding and non-re-bleeding incidences, the percentage of patients with bleeding from Kiesselbach’s area and treated with electrical coagulation was significantly lower and the percentage with bleeding from unidentifiable sites treated with gauze packing were significantly higher in patients with re-bleeding than in patients without re-bleeding. The percentages of patients with any systemic complications, including hypertension and anticoagulant therapy, were not higher in patients with re-bleeding than in patients without re-bleeding. Many patients required follow-up hospitalization, with 24% due to re-bleeding, 22% due to disturbance of consciousness, and 13% due to desire for hospitalization because of anxiety. Only 13% of patients had difficulty in hemostasis, a so-called absolute indication for hospitalization. The average hospitalization period was 7.8 days, including 10.4 days in patients with re-bleeding and 5.8 days in patients without re-bleeding. We suggest that 4 days is necessary for follow-up hospitalization of epistaxis, because follow-up hospitalization patients often developed re-bleeding, and all re-bleeding incidents occurred within 4 days. The initial treatment for patients with unidentifiable site epistaxis was gauze packing in 67%, with a rate of re-bleeding of 74%, and balloon tamponade in 15%, with a rate of re-bleeding of 50%. In 54% of unidentifiable site patients, the bleeding site was identified during hospitalization. We conclude that follow-up hospitalization, especially for intractable epistaxis, is of benefit to allow quick examination and identification of the bleeding site, and it could shorten the therapy period.