Epistaxis: Management Protocol As Per Etiology

Abstract

ABSTRACT Aim To underline a management protocol for epistaxis as per etiology so as to reduce associated morbidity of repeated packing, procedures and hospitalization. Materials and methods This was a prospective study carried out over a period of 2 years from January 2007 till December 2008 wherein all the cases that presented with a symptom of acute epistaxis to the emergency department of Fortis Hospital, Mohali were, enrolled into the study. These cases were evaluated for the brief history (a detailed history was taken after the primary management in majority of the cases), physical examination, diagnostic nasal endoscopy, radiology (if needed), hematological and biochemical profile and cross match (if needed). All these patients were hospitalized and were grouped into two groups on the basis of the age with group A having cases under 14 years of age and group B having cases more than 14 years of age. These cases were managed by a definitive management protocol stated in detail. Following this protocol for the management, we studied the duration of hospitalization for it and the frequency of repeated packing that patient had to undergo. Results A total of 97 cases were studied in this study with 26 cases in group A and 71 cases in group B. There was a male predominance with 20 males in group A and 52 males in group B. The most common etiology in group A was decrease in platelet count secondary to ITP (Idiopathic thrombocytopenic purpura) and in group B was accelerated hypertension. There was only anterior bleeding in only 10 of these cases and 81 cases had anterior and posterior bleeding. The cases were managed as per etiology following a management protocol and by this we could reduce hospitalization as in highlighted in the tables. Discussion There is no defined management protocol for the management of epistaxis as per the etiology though there are many studies on different treatment options used and its results. We here could follow a management protocol for different etiologies. Conclusion The management protocol as per etiology for hypertension if used can reduce the hospitalization and also associated morbidity of repeated packing considerably.