Management of epistaxis and complications associated with anterior nasal packing

Abstract

Study objectives: Epistaxis is a common illness, with 6% of the US population requiring medical attention at least once in their lifetime. Divergence exists in the clinical management of epistaxis patients with regard to prophylactic antibiotic use after nasal packing placement. However, there is no clear evidence in the literature to support this practice. The purpose of this study is to review the clinical practice of anterior epistaxis in an academic emergency department (ED) and describe the complications attributed to placement of packing in the anterior nare(s). Methods: This is a retrospective explicit chart review approved by the institutional review board and conducted in an ED with an annual census of 52,000 visits. Study dates were November 1, 2000, to October 31, 2001. Patients were identified using ED admission chief complaint. All patients recognized as having anterior epistaxis were included in the study. Posterior or postoperative epistaxis patients were excluded. A trained abstractor used a standardized sequential medical-record review to extract predefined variables including age, use of packing or cautery, the use of antibiotics, and the presence of subsequent complications. A complication was defined as a return to the ED for any reason. Results: The study cohort included 234 patients with anterior epistaxis. Eighty patients (34%) received anterior nasal packing; 154 patients (66%) did not. Seventy-nine (34%) patients received chemical cautery. Forty-nine (61%) of the patients who underwent nasal packing were placed on antibiotics. Of the 80 nasal packing patients who underwent nasal packing, 22 (28%) developed complications. In all instances, the complication was a recurrence of bleeding. Twenty-seven of the 154 (18%) patients who did not receive packing also returned with recurrence of bleeding. There was no significant difference in complication rates between patients who were packed, cauterized, or received no intervention. No patient returned to the ED with an infectious complication. Conclusion: Approximately one third of anterior epistaxis patients presenting to this ED received nasal packing. A high percentage of return ED visits was noted in patients discharged with and without packing, all for recurrence of anterior epistaxis. Regardless of antibiotic use, no infectious complications were cited in this cohort.