Community-based management of epistaxis: Who bloody knows?

Epistaxis occurs commonly in the general population, with most people experiencing at least 1 episode in a lifetime. The age of patients most affected by epistaxis follows a bimodal distribution, with the highest rates in those less than 10 years of age as well as those 70 years and older.1 Epistaxis is also commonly observed in clinical practice among patients taking antithrombotic therapies. As numerous cases are self-limiting and do not require patients to seek medical attention, the true incidence is likely not known. In an American study over a 10-year period, epistaxis was responsible for 1 in 200 emergency room (ER) visits, 6% of which required hospitalization.1 Hospitalizations for epistaxis may incur significant costs, with a reported average hospital length of stay (LOS) of 3.24 days, resulting in costs totalling from $6,000 to $17,000 depending on the treatment strategy used.2 However, many cases of epistaxis may be safely managed in the community,3 and providing patients with education on general measures for management and product options may mitigate the need for hospital-based care. In this context, community-based health care practitioners are the first points of contact. In order for practitioners to provide appropriate advice to these patients, it is necessary to have an understanding of the etiology, risk factors and appropriate outpatient treatment strategies for managing epistaxis. As such, our purpose is to provide an overview of community-based management of epistaxis, with a practice tool for health care providers outlining a suggested approach to management in this setting, along with an educational infographic for patients. The treatment of epistaxis in children or in patients with hereditary hemorrhagic telangiectasia is beyond the scope of our review and will not be addressed here