How well are we managing epistaxis cases?
Reviewed by Madhup K Chaurasia

Epistaxis constitutes 34.5% of all emergency admissions to otolaryngology departments nation-wide. Presently there are no detailed consensus guidelines for this commonest emergency, and there is tremendous variation of practice. Quite often, non-ENT trained doctors manage this emergency. This paper reviews practice of epistaxis management in six hospitals in the UK with regard to set standards aiming at a 100% target in terms of appropriate practice of managing epistaxis. This involves initial examination and attempt at nasal cautery to avoid hospital admission, early surgical or radiological intervention to avoid prolonged nasal packing and post-bleeding nasal examination to evaluate underlying causes and consider further treatment or evaluation to identify relevant pathology. The survey revealed that there was poor documentation of nasal examination and junior staff were not complying with the universally accepted minimum standard of written communication. Only 9% of patients received surgery or embolisation. Of all cases eligible for surgical or radiological intervention, the proportion of those receiving this varied from 12.5 to 28% which is remarkably low. This may have been due to non-availability of senior staff. The length of stay averaged 1.9 days. A suggestion is made for having designated centres for epistaxis but the idea verges on idealism rather than practicality. Epistaxis is the commonest emergency which can present with extreme urgency and affects mainly the elderly. It should be manageable locally and provide the basics of otolaryngology emergency service for which any consultant should be available and able to handle it.

A multi-centre audit of epistaxis management in England: is there a case for a national review of practice?
Hall AC, Blanchford H, Chatrath P, Hopkins C.
THE JOURNAL OF LARYNGOLOGY AND OTOLOGY
2015;129:454-7.