Early versus delayed treatment of primary epistaxis in the United States

Abstract

Background: Epistaxis treatment is variable. This study sought to determine demographic, management, and outcome differences in patients treated with early (<24 hours) vs late ligation or embolization.

Methods: This study was a retrospective review of the 2008 to 2010 Nationwide Inpatient Sample (NIS) for patients admitted with epistaxis. Hospital and patient demographics and outcomes were compared between early vs late surgical intervention. Multivariate models analyzed the economic measures (length of stay and hospital charges) between early and late treatment.

Results: Of 57,039 cases of primary epistaxis identified in the NIS database, 4662 (8.2%) received ligation or embolization. There was no significant influence of early treatment on the odds of mortality, stroke, blindness, or blood transfusion. The total charges and length of stay were significantly reduced for early surgical intervention using embolization or ligation. Two predictors of early intervention were common to both ligation and embolization: (1) weekday admission (p < 0.001; odds ratio [OR], 1.856), and (2) admission to a non-Midwest hospital (p < 0.001; OR, 3.276). Additional predictors of early intervention with ligation included: (1) admission to an urban hospital; (2) admission to a nonteaching hospital; (3) black race; and (4) income >$39,000. The odds of embolization within the first 24 hours were lowered with each additional chronic condition (p = 0.017; OR, 0.912).

Conclusion: Efficient and effective healthcare delivery is paramount given the potentially life-threatening nature of epistaxis and the current economic environment. Delayed intervention significantly increased hospital charges and length of stay. Rapid identification and treatment may prove to be a cost-saving measure.

Keywords: embolization; epistaxis; epistaxis outcomes; ligation; nationwide inpatient sample.