Epidemiology of epistaxis in US emergency departments, 1992 to 2001.
OBJECTIVE
The epidemiology of emergency department (ED) visits for epistaxis is unknown. We use national data to fill this gap and test hypotheses that epistaxis visits are more common with increasing age and in winter.


METHODS
We identify ED visit with epistaxis from 10 years of the National Hospital Ambulatory Medical Care Survey. We calculate visit rates by age and other demographic characteristics and assess mode of arrival and disposition. Results are presented with 95% confidence intervals (CIs).


RESULTS
From 1992 to 2001, epistaxis occurred at 4,503,000 ED visits, or 0.46% (95% CI 0.41% to 0.51%) of all visits. Per 1,000 population, 1.7 (95% CI 1.5 to 1.9) ED visits for epistaxis occurred annually. The age-related frequency was bimodal, with peaks among those younger than 10 years (4.0 per 1,000 visits) and aged 70 to 79 years (12.0 per 1,000 visits). Most cases (83%; 95% CI 80% to 86%) were atraumatic. Traumatic cases were younger than atraumatic cases (mean age 31 versus 49 years). From December to February, atraumatic epistaxis occurred in 0.50% (95% CI 0.40% to 0.60%) of all visits versus 0.34% (95% CI 0.30% to 0.39%) during nonwinter months. Fifteen percent (95% CI 12% to 18%) of cases arrived by ambulance, and 6% (95% CI 5% to 7%) of patients were hospitalized.


CONCLUSIONS
Epistaxis accounts for about 1 in 200 ED visits in the United States. Although there is an early age peak (age >10 years), the frequency increases from age 20 years onward, with the highest rates in the elderly. Epistaxis visits are more common in the winter. Future efforts to decrease epistaxis visits might focus on education of the elderly and parents of young children about nasal mucosa care and basic approaches to home management.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Daniel J
DJ
Pallin
Yi-Mei
YM
Chng
Mary Patricia
MP
McKay
Jennifer A
JA
Emond
Andrea J
AJ
Pelletier
Carlos A
CA
Camargo
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004844:Epistaxis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data; D012621:Seasons; D017678:Sex Distribution; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology