Clinical Practice Guideline: Nosebleed (Epistaxis)
2019 AAO-HNSF Annual Meeting & OTO Experience
Keyword(s)
Nosebleed, epistaxis, emergency department, inpatient hospital, telemedicine
Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the USA. While the great majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, the target patient with a nosebleed is defined as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient's quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds. The primary purpose of this multidisciplinary guideline is to identify quality improvement opportunities in the management of nosebleeds and to create clear and actionable recommendations to implement these opportunities in clinical practice. The target patient for the guideline is any individual aged 3 years and older with a nosebleed or history of nosebleed, who needed medical treatment or sought medical advice. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, emergency department, inpatient hospital, and telemedicine.
Description
Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the USA. While the great majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, the target patient with a nosebleed is defined as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient's quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds. The primary purpose of this multidisciplinary guideline is to identify quality improvement opportunities in the management of nosebleeds and to create clear and actionable recommendations to implement these opportunities in clinical practice. The target patient for the guideline is any individual aged 3 years and older with a nosebleed or history of nosebleed, who needed medical treatment or sought medical advice. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, emergency department, inpatient hospital, and telemedicine.Learning Objectives: 1. Identify quality improvement opportunities in the management of nosebleeds. 2. Improve quality of care outcomes for nosebleed patients. 3. Recognize the existing variations in practice and the quality improvement opportunities.Faculty: David Tunkel, MD(Salary: Medtronic; Salary: Allergan and Merz; Expert Witness: several law practices; Consulting Fees: Otic Pharma), Spencer Payne, MD(Expert Witness: Various firms; Research funding: Acclarent; Allakos; Cumberland; Astra-Zeneca; Leadership Role: American Rhinologic Society; Consulting Fees: Cook Medical), Stacey Ishman, MD, MPH(Research funding: National Institute of Health; American Society of Pediatric Otolaryngology; Research funding: Inspire medical; Leadership Role: International Surgical Sleep Society; American Society of Pediatric Otolaryngology; ABOTO; Consulting Fees: Medtronic; Genus Lifesciences), Rachel Bercovitz(Did Not Disclose).
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