Journal of Nature and Science of Medicine

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 2  |  Issue : 2  |  Page : 61--63

Recent insight into the prevalence, etiology, and outcome of epistaxis in a university hospital in Saudi Arabia


Sami E Alharethy 
 Department of ENT and HNS, Division of Facial Plastic Surgery, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia

Correspondence Address:
Sami E Alharethy
Department of ENT and HNS, Division of Facial Plastic Surgery, King Abdulaziz University Hospital, King Saud University, P. O. Box 245, Riyadh 11411
Saudi Arabia

Abstract

Objectives: The objective of the study is to study the prevalence, pattern, etiology, and outcome of epistaxis in a tertiary university hospital. Methods: A retrospective study conducted at King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia, from January 2014 to January 2017. Patients' demographics, causes of bleeding, and management techniques were recorded. This study was approved by the Institutional Review Board at King Saud University. Results: A total of 1126 patients had an epistaxis prevalence rate of 0.98% of all emergency visits. There were 462 males (41.0%) and 664 females (59.0%). The mean age was 39.1 years (from 6 to 74 years). The highest number of patients with epistaxis was 340 (30.2%) in age group of 41–50 years. The mean height was 144.6 cm and the mean weight was 56 kg. The most common cause of epistaxis was idiopathic in 353 (31.3%) patients. A total of 510 (45.3%) patients had an anterior bleeding site, while 152 (13.5%) had bilateral bleeding. The diagnosis was reached both endoscopic and clinical. The majority were treated with a nonsurgical method; anterior packing was successful in 840 (74.6%) patients and chemical and electric cautery in 80 (7.1%) patients. There was a history of recurrent epistaxis in 46 children (4.1%). No mortality occurred during the study period. Conclusion: Epistaxis is common in Saudi Arabia. The age group of 41–50 years is more prone to epistaxis with a prevalence of 30.2%. Exposure to dry, hot weather, idiopathic, and hypertension are the frequent causes. Packing and cauterization successfully treated epistaxis in most cases, and there were no cases with mortality.



How to cite this article:
Alharethy SE. Recent insight into the prevalence, etiology, and outcome of epistaxis in a university hospital in Saudi Arabia.J Nat Sci Med 2019;2:61-63


How to cite this URL:
Alharethy SE. Recent insight into the prevalence, etiology, and outcome of epistaxis in a university hospital in Saudi Arabia. J Nat Sci Med [serial online] 2019 [cited 2019 Jul 18 ];2:61-63
Available from: http://www.jnsmonline.org/text.asp?2019/2/2/61/245410


Full Text



 Introduction



Epistaxis is a serious health concern. It has been reported to occur in up to 60% of the general population.[1],[2] The peak incidences are in the extremes of age, young, and elderly. Epistaxis has a gender predilection, and females are more prone to epistaxis.[1],[2] Epistaxis is often recurrent in rare cases; however, massive nasal bleeding can lead to death.[3],[4] The causes of the epistaxis are nasal, such as trauma, tumor, ulceration of nasal mucosa by nose picking,[5] and allergic rhinitis.[6] There are also systemic causes such as hypertension[7],[8],[9] and environmental contributors such as a dry, hot atmosphere, and winter season.[10],[11],[12]

 Methods



A retrospective chart review was conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, from January 2014 to January 2017. All records reporting the occurrence of epistaxis in the emergency department were analyzed. Patients' demographics, such as age, sex, and body mass index; identifiable causes for epistaxis; comorbidities, such as diabetes and hypertension; medication use; and history of epistaxis were evaluated. The length of the hospital stay and history of blood transfusion were also noted. The management of epistaxis and treatment outcome was recorded. This study was approved by the Institutional Review Board at King Saud University.

 Results



A total of 1126 patients diagnosed with epistaxis were based on emergency room registry. The epistaxis prevalence rate was 0.98% of total emergency admissions. There were 462 males (41.0%) and 664 females (59.0%). The mean age was 39.1 years, which ranged from 6 to 74 years. The highest number of patients with epistaxis was 340 (30.2%) in the age group of 41–50 years, which was followed by 197 (17.5%) patients in the age group from 51 to 60 years. The mean height was 144.6 cm and mean weight was 56 kg. These results are shown in [Table 1]. About 28.6% of studied participants were known diabetics and 30.2% were hypertensive.{Table 1}

Allergic rhinitis and nose picking that lead to inflammation and ulceration were prominent causes of epistaxis in nearly 18.4% of patients. A history of recurrent epistaxis was found in 46 (4.1%) patients. There was no malignancy or mortality during the study period. These results are shown in [Figure 1].{Figure 1}

Five hundred and ten patients (45.3%) had an anterior bleeding site from the nasal septum, especially Little's area, which is where the Kiesselbach's plexus forms. In 169 (15.0%) of patients, the site of the bleeding was posterior from deeper nose structures of the nose. Two hundred and ninety-five (26.2%) patients had bleeding from the lateral wall, while 152 (13.5%) patients had bilateral bleeding. These results are shown in [Table 2].{Table 2}

In the majority of the cases, packing with supportive medication controlled bleeding from the nose. Posterior packing plus supportive medication was provided for 188 (16.7%) patients. Chemical and electric cautery under local anesthesia was performed in 80 (7.1%) patients. Eighteen patients required hospital admission with endoscopic sphenopalatine artery ligation to stop the bleeding. One patient required a blood transfusion during his stay in hospital, and there was no hospital mortality reported due to epistaxis during the study period. The average hospital stay was 2 days. These results are shown in [Table 3].{Table 3}

 Discussion



Epistaxis is a frequent problem that creates great apprehension and health concerns, especially if the bleeding is too much and the patient is a child or an elderly person. In the present study, the vulnerable age group was approximately 41–50 years old with comorbidities such as diabetes mellitus or hypertension. Some previous studies have reported a bimodal age distribution of epistaxis patients.[3] However, there was a similar association and adverse effect of old age, diabetes, and hypertension on epistaxis reported in previous studies.[13],[14],[15] In fact, diabetes and hypertension cause atherosclerosis of the blood vessels, making them more vulnerable to bleeding. A recent systematic review found that six out of nine studies agree that arterial pressure is higher at the time of epistaxis compared to the control group or general population.[16]

Saudi Arabia has a very dry, hot climate, especially during summer, which makes outdoor activity difficult. Weather influences epistaxis. However, our findings differ from previous studies that have reported epistaxis to be more common in winter.[10],[17] The most common cause of epistaxis in the present study was idiopathic. Similar findings were previously reported.[18] Allergic rhinitis with mucosal inflammation and nose picking leading to mucosal ulceration and bleeding accounted for 13.5% of epistaxis cases. Recurrent epistaxis occurred in 4% of cases.

 Conclusion



Epistaxis accounts for approximately 1% of hospital emergency visits in a teaching tertiary hospital in Saudi Arabia. New insight into the trends is needed to develop preventive strategies.

Limitation of this study

The limitation of this study is that it is conducted at a single tertiary hospital.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Pollice PA, Yoder MG. Epistaxis: A retrospective review of hospitalized patients. Otolaryngol Head Neck Surg 1997;117:49-53.
2Rubin Grandis J. Continuing Education Program. The Management of Epistaxis. 3rd ed. United States, Alexandria, VA: American Academy of Otolaryngology–Head and Neck Surgery Foundation; 1999.
3Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician 2005;71:305-11.
4Tan LK, Calhoun KH. Epistaxis. Med Clin North Am 1999;83:43-56.
5Veeravagu A, Joseph R, Jiang B, Lober RM, Ludwig C, Torres R, et al. Traumatic epistaxis: Skull base defects, intracranial complications and neurosurgical considerations. Int J Surg Case Rep 2013;4:656-61.
6McDougal BJ. Allergic rhinitis – A cause of recurrent epistaxis. J Am Vet Med Assoc 1977;171:545-6.
7Herkner H, Laggner AN, Müllner M, Formanek M, Bur A, Gamper G, et al. Hypertension in patients presenting with epistaxis. Ann Emerg Med 2000;35:126-30.
8Isezuo SA, Segun-Busari S, Ezunu E, Yakubu A, Iseh K, Legbo J, et al. Relationship between epistaxis and hypertension: A study of patients seen in the emergency units of two tertiary health institutions in Nigeria. Niger J Clin Pract 2008;11:379-82.
9Fuchs FD, Moreira LB, Pires CP, Torres FS, Furtado MV, Moraes RS, et al. Absence of association between hypertension and epistaxis: A population-based study. Blood Press 2003;12:145-8.
10Sowerby LJ, DeSerres JJ, Rudmik L, Wright ED. Role of season, temperature and humidity on the incidence of epistaxis in Alberta, Canada. J Otolaryngol Head Neck Surg 2014;43:10.
11Kemal O, Sen E. Does the weather really affect epistaxis? B-ENT 2014;10:199-202.
12Ando Y, Iimura J, Arai S, Arai C, Komori M, Tsuyumu M, et al. Risk factors for recurrent epistaxis: Importance of initial treatment. Auris Nasus Larynx 2014;41:41-5.
13Varshney S, Saxena RK. Epistaxis: A retrospective clinical study. Indian J Otolaryngol Head Neck Surg 2005;57:125-9.
14Page C, Biet A, Liabeuf S, Strunski V, Fournier A. Serious spontaneous epistaxis and hypertension in hospitalized patients. Eur Arch Otorhinolaryngol 2011;268:1749-53.
15Abrich V, Brozek A, Boyle TR, Chyou PH, Yale SH. Risk factors for recurrent spontaneous epistaxis. Mayo Clin Proc 2014;89:1636-43.
16Kikidis D, Tsioufis K, Papanikolaou V, Zerva K, Hantzakos A. Is epistaxis associated with arterial hypertension? A systematic review of the literature. Eur Arch Otorhinolaryngol 2014;271:237-43.
17Nunez DA, McClymont LG, Evans RA. Epistaxis: A study of the relationship with weather. Clin Otolaryngol Allied Sci 1990;15:49-51.
18Iseh KR, Muhammad Z. Pattern of epistaxis in Sokoto, Nigeria: A review of 72 cases. Ann Afr Med 2008;7:107-11.