title: Risk factors for recurrent epistaxis: importance of initial treatment.
abstract: OBJECTIVE
  A retrospective study of risk factors for recurrent epistaxis and initial treatment for refractory posterior bleeding was performed. Based on the results, proposals for appropriate initial treatment for epistaxis by otolaryngologists are presented.
  
  
  METHODS
  The data of 299 patients with idiopathic epistaxis treated during 2008-2009 were analyzed by multivariate logistic regression analysis. Treatment data for 101 cases of posterior bleeding were analyzed using the chi-square test.
  
  
  RESULTS
  Recurrent epistaxis occurred in 32 cases (10.7%). Unidentified bleeding point (adjusted odds ratio (OR) 5.67, 95% confidence interval (CI) 1.83-17.55, p=0.003) was predictive of an increased risk of recurrent epistaxis, and electrocautery (adjusted odds ratio (OR) 0.07, 95% confidence interval (CI) 0.03-0.17, p=0.000) was predictive of a decreased risk of recurrent epistaxis. In terms of initial treatment for posterior bleeding, the rate of recurrent epistaxis was significantly lower for patients who underwent electrocautery as initial treatment compared with those who did not (6.4% vs. 40.7%, p<0.01), and it was significantly higher for those who underwent endoscopic gauze packing compared with those who did not (39.5% vs. 15.9%, p<0.01).
  
  
  CONCLUSIONS
  In the present study, the risk factors for recurrent epistaxis were unidentified bleeding point. Thus, it is important to identify and cauterize a bleeding point to prevent recurrent epistaxis. The present results also suggest the effectiveness of electrocautery and the higher rate of recurrent epistaxis for patients who underwent gauze packing as initial treatment for posterior bleeding. Electrocautery should be the first-choice treatment of otolaryngologists for all bleeding points of epistaxis, and painful gauze packing may be inadvisable for posterior bleeding. More cases of posterior bleeding are needed for future studies involving multivariate analyses and appropriate analyses of factors related to hospitalization, surgery, and embolization.
authors.affiliation: Department of Otorhinolaryngology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan. Electronic address: andoh.ent@gmail.com.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ando
authors.affiliation: Department of Otorhinolaryngology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Iimura
authors.affiliation: Department of Otorhinolaryngology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Arai
authors.affiliation: Department of Otorhinolaryngology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Arai
authors.affiliation: Department of Otorhinolaryngology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Komori
authors.affiliation: Department of Otorhinolaryngology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan.
authors.forename: Matsusato
authors.initials: M
authors.lastname: Tsuyumu
authors.affiliation: Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Hama
authors.affiliation: Department of Otorhinolaryngology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shigeta
authors.affiliation: Department of Otorhinolaryngology, Jikei University Daisan Hospital, 4-11-1, Izumi-honcho, Komae-shi, Tokyo 201-8601, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hatano
authors.affiliation: Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Moriyama
mesh_terms: D000328:Adult; D000368:Aged; D004564:Electrocoagulation / Q000379:methods; D004724:Endoscopy / Q000379:methods; D004844:Epistaxis / Q000628:therapy*; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013630:Tampons, Surgical
keywords: Endoscopic electrocautery; Gauze packing; Recurrent epistaxis; Risk factor; Unidentified bleeding point