Management paradigms for posterior epistaxis: A comparison of costs and complications.
OBJECTIVE
Posterior epistaxis is a common otolaryngologic emergency. Management is controversial because of the many treatment options available. These options vary in efficacy, rates of complications, and cost. Posterior nasal packing is the medical management most frequently used to control posterior epistaxis. It is associated with major complications, including stroke, myocardial infarction, arrhythmias, and death. Because of these potential complications, many otolaryngologists monitor patients with posterior nasal packing in the intensive care unit (ICU). However, the level of care used to monitor these patients is variable, and standards have not been established.


METHODS
From 1991 to 1997, 46 patients had posterior nasal packing placed to control epistaxis. Management, complications, and hospital charges were analyzed.


RESULTS
Six patients (13%) were admitted to the ICU, 2 (4%) were admitted for telemetry monitoring, and 38 (83%) were sent to the ENT ward for continuous pulse oximetry. Four major complications occurred (1 episode of syncope [emergency department], 2 arrhythmias [ICU], and 1 death [hospice]). Twenty-six patients were treated with posterior packing in the ENT ward, at a mean cost of $2988. Fourteen patients underwent intervention (5 ligations, 6 endoscopic cauterizations, and 3 angiograms), with a mean cost of $5482. Six patients spent time in the ICU, with a mean cost of $8242. Patients treated in the ENT ward had significantly lower costs than those undergoing intervention (P = 0.017) or those admitted to the ICU (P = 0.020).


CONCLUSIONS
We propose that most patients with posterior epistaxis can be treated in specialized ENT wards. This can be done without increasing complications and with significantly decreased costs.
Monte
E D
ED
Department of Otolaryngology Head and Neck Surgery, State University of New York at Buffalo, USA.
Belmont
M J
MJ
Wax
M K
MK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004638:Emergency Treatment; D004844:Epistaxis / Q000191:economics* / Q000628:therapy*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000592:standards; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009518:New York; D010092:Oximetry; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies