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Laryngorhinootologie 2016; 95(12): 837-842
DOI: 10.1055/s-0042-111013
Originalie
© Georg Thieme Verlag KG Stuttgart · New York

Ein Jahr Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer HNO-Kliniken

One Year Treatment of Nose Bleeding in the ENT Emergency Departments of East Thuringia
K. Weigel
1   HNO-Klinik, Universitätsklinikum Jena, Jena, Germany
,
G. F. Volk
1   HNO-Klinik, Universitätsklinikum Jena, Jena, Germany
,
A. Müller
2   SRH Wald-Klinikum Gera, Klinik für HNO-Heilkunde/Plastische Operationen, Gera, Germany
,
O. Guntinas-Lichius
1   HNO-Klinik, Universitätsklinikum Jena, Jena, Germany
› Author Affiliations
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Publication History

eingereicht 16 June 2016

akzeptiert 21 June 2016

Publication Date:
03 November 2016 (online)

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Zusammenfassung

Hintergrund: Ziel war die Analyse der Versorgungsrealität der Behandlung der Epistaxis in der Notfallbehandlung in einer HNO-Klinik.

Material und Methoden: In den Ostthüringer HNO-Kliniken in Jena und Gera stellten sich im Jahr 2009 690 Patienten mit 862 Ereignissen einer Epistaxis vor (60% Männer, mittleres Alter: 60 Jahre). Die Charakteristika der Patienten wurden retrospektiv mit Blick auf die Komorbidität, Dauermedikation und Behandlungsmaßnahmen ausgewertet.

Ergebnisse: Die Inzidenz für die Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer Kliniken lag bei 121,28 pro 100 000 Einwohner Ostthüringens. Die häufigste Komorbidität war die Hypertonie (68% der Patienten). 27% der Patienten nahmen Thrombozytenaggregationshemmer und 19% Antikoagulantien ein. Als unabhängige Risikofaktoren für rezidivierende Epistaxis mit der Notwendigkeit einer erneuten Notfallbehandlung wurden die 3-fach Kombination antikoagulativer und Thrombozytenaggregations-hemmender Medikation (p=0,015), Morbus Osler (p=0,011) und Thrombozytopenie (p=0,009) identifiziert. Die angewendeten Therapiemaßnahmen in über 90% erfolgreich.

Schlussfolgerung: Die derzeitige HNO-Notfallbehandlung der Epistaxis in Notfallambulanzen von Kliniken erscheint effizient. Die Eskalation der antikoagulativen Dauermedikationen erhöht die stationäre Behandlungsnotwendigkeit. Weiterführende Analysen der Versorgungsrealität und Risikofaktoren sind notwendig, um eine Patientenstratifizierung im klinischen Alltag und Leitlinie zum Epistaxismanagement zu entwickeln.

Abstract

Objective: Aim of the study was to analyse the medical care situation of patients suffering from epistaxis in everyday clinical practice in ENT emergency departments.

Material and Methods: In the year 2009, 690 patients with 862 occurrences of epistaxis sought help in the 2 East Thuringian ENT emergency departments in Jena and Gera (60% male, average age: 60 years). The patients’ characteristics were evaluated retrospectively with a focus on comorbidity, long-term medication and treatment measures.

Results: The incidence of epistaxis treatment in the ENT emergency departments was 121 28 per 100 000 habitants of East Thuringia. Die Inzidenz für die Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer Kliniken lag bei 121 28 pro 100 000 Einwohner Ostthüringens The most common comorbidity was hypertension (68% of all patients). 27% of all patients were taking antiplatelet drugs and 19% anticoagulants. We identified the 3-fold combination of a medication with anticoagulant and antiplatelet drugs (p=0.015), Morbus Osler (p=0.011) and thrombocytopaenia (p=0.009) as independent risk factors for recurrent epistaxis. The therapeutic measures the patients led to success rates of more than 90%.

Conclusion: The actual ENT emergency treatment of epistaxis seems to be efficient. The escalation of anticoagulant long-term drug therapy has resulted in more admittance to the inpatient sector. More analyses of medical care situations and factors have to be carried out to develop a patient stratification for the daily clinical practice as well as a general guideline for the management of epistaxis.

Schlüsselwörter

Rhinologie - Nasenbluten - Versorgungsforschung - Risikofaktoren - Therapie

Key words

Rhinology - Nose bleeding - Health care research - risk factors - Therapy
 

  • Literatur

  • 1 Smith J, Siddiq S, Dyer C, Rainsbury J, Kim D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol 2011; 125: 38-42
    Google Scholar
  • 2 Weiss NS. Relation of high blood pressure to headche, epistaxis, and selected other symptoms. The United States Health Examination Survey of Adults. New Engl J Med 1972; 287: 631-633
    CrossrefPubMedGoogle Scholar
  • 3 Saro R. Die Ursachen und Therapie der symptomatischen Epistaxis: Eine statistische Auswertung von 4 338 Krankengeschichten aus dem Zeitraum 1975-1980. Berlin: Univ. Diss; 1982
    Google Scholar
  • 4 Arnold W, Ganzer U. Checkliste Hals-Nasen-Ohrenheilkunde. Stuttgart, New York: Georg Thieme Verlag; 2011
    Article in Thieme ConnectGoogle Scholar
  • 5 Yau S. An update on epistaxis. Austr Fam Phys 2015; 44: 653-656
    PubMedGoogle Scholar
  • 6 Weller P, Christov F, Bergmann C, Lang S, Lehnerdt G. Behandlung rezidivierender Epistaxis durch Gefäßligatur: zeitgerecht oder überholt?. Laryngorhinootol 2014; 93: 665-670
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Tseng EY, Narducci CA, Willing SJ, Sillers MJ. Angiographic embolization for epistaxis: a review of 114 cases. Laryngoscope 1998; 108: 615-619
    Google Scholar
  • 8 Christensen NP, Smith DS, Bamwell SL, Wax MK. Arterial embolization in the management of posterior epistaxis. Otolaryngol Head Neck Surg 2005; 133: 748-753
    CrossrefPubMedGoogle Scholar
  • 9 Pollice PA, Yoder MG. Epistaxis: A retrospective review of hospitalized patients. Otolaryngol Head Neck Surg 1997; 117: 49-53
    CrossrefPubMedGoogle Scholar
  • 10 Reiß M, Reiß G. Epistaxis: some aspects of laterality in 326 patients. Eur Arch Otorhinolaryngol 2012; 269: 905-909
    CrossrefPubMedGoogle Scholar
  • 11 Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo Jr CA. Epidemiology of Epistaxis in US Emergency Departments, 1992 to 2001. Ann Emerg Med 2005; 46: 77-81
    PubMedGoogle Scholar
  • 12 Klossek JM, Dufour X, de Montreuil CB, Fontanel JP, Peynègre R, Reyt E, Rugina M, Samardzic M, Serrano E, Stoll D, Chevillard C. Epistaxis and its management: an observational pilot study carried out in 23 hospital centres in France. Rhinology 2006; 44: 151-155
    PubMedGoogle Scholar
  • 13 Huang CL, Shu CH. Epistaxis: A Review of Hospitalized Patients. Chin Med J 2002; 65: 74-78
    PubMedGoogle Scholar
  • 14 Monjas-Cánovas I, Hernández-García I, Mauri-Barberá J, Sanz-Romero B, Gras-Albert JR. Epidemiology of epistaxis admitted to a tertiary hospital. Acta Otorrinolaringol Espan 2010; 61: 41-47
    PubMedGoogle Scholar
  • 15 Juselius H. Epistaxis. A clinical study of 1,724 patients. J Laryngol Otol 1974; 88: 317-327
    CrossrefPubMedGoogle Scholar
  • 16 Simmen D, Heinz B. Epistaxis-Strategie – Erfahrungen der letzten 360 Hospitalisationen. Laryngorhinootol 1998; 77: 100-106
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Jackson KR, Jackson RT. Factors associated with active, refractory epistaxis. Arch Otolaryngol Head Neck Surg 1988; 114: 862-865
    CrossrefPubMedGoogle Scholar
  • 18 Purkey MR, Seeskin Z, Chandra R. Seasonal variation and predictors of epistaxis. Laryngoscope 2014; 124: 2028-2033
    Google Scholar
  • 19 Stopa R, Schönweiler R. Causes of epistaxis in relation to season and weather status. HNO 1989; 37: 198-202
    Google Scholar
  • 20 Nunez DA, McClymont LG, Evans RA. Epistaxis: a study of the relationship with weather. Clinical Otolaryngol 1990; 15: 49-51
    PubMedGoogle Scholar
  • 21 Danielides V, Kontogiannis N, Bartzokas A, Lolis CJ, Skevas A. The influence of meteorological factors on the frequency of epistaxis. Clin Otolaryngol 2002; 27: 84-88
    CrossrefPubMedGoogle Scholar
  • 22 McLarnon CM, Carrie S. Epistaxis. Surgery (Oxford) 2012; 30: 584-589
    PubMedGoogle Scholar
  • 23 Douglas R, Wormald PJ. Update on epistaxis. Curr Opin Otolaryngol Head Neck Surg 2007; 15: 180-183
    CrossrefPubMedGoogle Scholar
  • 24 Poulsen P. Epistaxis. Examination of hospitalized patients. J Laryngol Otol 1984; 98: 277-279
    PubMedGoogle Scholar
  • 25 Fuchs FD, Moreira LB, Pires CP, Torres FS, Furtado MV, Moraes RS, Wiehe M, Fuchs SC, Lubianca Neto JF. Absence of Association between Hypertension and Epistaxis: a Population-based Study. Blood Pres 2003; 12: 145-148
    PubMedGoogle Scholar
  • 26 Page C, Biet A, Liabeuf S, Strunski V, Fournier A. Serious spontaneous epistaxis and hypertension in hospitalized patients. Eur Arch Otorhinolaryngol 2011; 268: 1749-1753
    CrossrefPubMedGoogle Scholar
  • 27 Sarhan NA, Algamal AM. Relationship between epistaxis and hypertension: A cause and effect or coincidence?. J Saudi Heart Ass 2015; 27: 79-84
    PubMedGoogle Scholar
  • 28 Herkner H, Havel C, Müllner M, Gamper G, Bur A, Temmel AF, Laggner AN, Hirschl MM. Active Epistaxis at ED Presentation is Associated With Arterial Hypertension. Am J Emerg Med 2002; 20: 92-95
    CrossrefPubMedGoogle Scholar
  • 29 Herkner H, Laggner AN, Müllner M, Formanek M, Bur A, Gamper G, Woisetschläger C, Hirschl MM. Hypertension in patients presenting with epistaxis. Ann Emerg Med 2000; 35: 126-130
    Google Scholar
  • 30 Lubianca Neto JF, Fuchs FD, Facco SR, Gus M, Fasolo L, Mafessoni R, Gleissner AL. Is epistaxis evidence of end-organ damage in patients with hypertension?. Laryngoscope 1999; 109: 1111-1115
    CrossrefPubMedGoogle Scholar
  • 31 Abrich V, Brozek A, Boyle TR, Chyou PH, Yale SH. Risk factors for recurrent spontaneous epistaxis. Mayo Clin Proc 2014; 89: 1636-1643
    CrossrefPubMedGoogle Scholar
  • 32 Tay HL, Evans JM, McMahon AD, MacDonald TM. Aspirin, nonsteroidal anti-inflammatory drugs, and epistaxis. A regional record linkage case control study. Ann Otol Rhinol Laryngol 1998; 107: 671-674
    CrossrefPubMedGoogle Scholar
  • 33 Karsen H, Duygu F, Yapici K, Baran AI, Taskiran H, Binici I. Severe Thrombocytopenia and Hemorrhagic Diathesis due to Brucellosis. Arch Iran Med 2012; 15: 303-306
    PubMedGoogle Scholar
  • 34 Kjeldsen AD, Andersen PE, Tørring PM. Diagnosis and treatment of Morbus Osler. Ugeskr Laeger 2011; 173: 490-495
    PubMedGoogle Scholar
  • 35 Kotecha B, Fowler S, Harkness P, Walmsley J, Brown P, Topham J. Management of epistaxis: a national survey. Ann R Coll Surg Engl 1996; 78: 444-446
    PubMedGoogle Scholar
  • 36 Padgham N. Epistaxis: anatomical and clinical correlates. J Laryngl Otol 1990; 104: 308-311
    PubMedGoogle Scholar
  • 37 Ahmed A, Woolford TJ. Endoscopic bipolar diathermy in the management of epistaxis: an effective and cost-efficient treatment. Clin Otolaryngol All Sci 2003; 28: 273-275
    PubMedGoogle Scholar
  • 38 Razdan U, Raizada RM, Chaturvedi VN. Efficacy of conservative treatment modalities used in epistaxis. Ind J Otolaryngol Head Neck Surg 2004; 56: 20-22
    PubMedGoogle Scholar