First Evidence-Based Clinical Guideline on Epistaxis by American Academy of Otolaryngology

Epistaxis is the most common medical problem which occurs in at least 60% of Americans Academy of Otolaryngology-Head and Neck Surgery Foundation has recently published the new clinical practice guidelines on Nosebleed (epistaxis).

Click here to read the complete guidelines. 

The chairman, David E. Tunkel of the guideline development group (GDG) said that the diagnosis and treatment methods for epistaxis have been used uniformly across the settings and clinicians. It is helpful for addressing the gap and to help to reduce the variations in medical care. This clinical guideline provides recommendations based on the evidence for improving quality care.

The American Academy of Otolaryngology is the world’s largest organization having 13,000 specialists of nose, ears, and throat. It is the earliest medical specialty in the United States. They develop evidence-based clinical practice guidelines with input from the different groups of medical specialties, health professionals, nurses and other clinicians where appropriate.

Epistaxis is a nose hemorrhage, a frequent complaint of emergency department usually causing significant anxiety among patients and clinicians. Seventy percent of cases occur spontaneously. Approximately 90 percent of epistaxis arises from the small area near the caudal septum. Almost 6% of cases require medical care or surgical intervention and approximately 0.2% need hospitalization.

Bleeding occurs in the nasal cavity or nasopharynx from the nostrils. Nose bleeding usually happens without any obvious reason and more often occurs in the elderly people and the children. The latest study which is based on the data outcomes from the Nationwide Emergency Department Sample identified 1.2 million nosebleed cases in an emergency from 2009 to 2011.

The nosebleed care ranges from the self-treatment, conventional home remedies, procedure intervention in clinics, hospitals, emergency departments, and operating rooms. This recent clinical practice guideline is for those patients who can’t handle such situations through self-treatment and have severe bleeding to permit medical care or advice. This includes severe, recurrent and persistent bleeding that it may affect an individual’s quality of life.

Dr. Tunkel said that it is the first-ever evidence-based multidisciplinary guideline on epistaxis developed in the U.S. It helps clinicians in knowing the evidence and areas needing improvement of practice such as giving instructions about nasal packing care to patients. After the review of the literature, these instructions were made by the guideline panel.

The guideline defines the actionable clear recommendations for the implementation of the quality improvement circumstances in the clinical practice. The GDG utilized research based on the evidence from five clinical guidelines, 16 randomized trials, 17 systematic reviews and 203 different related studies for informing the Key Action Statements (KASs) for patient care.

The selected patient for this guideline is the individual who 3 years old or older than that is having nosebleed o history of nosebleed that seeks medical care or needs treatment. The targeted audience for this guideline includes clinicians evaluating and treating nosebleed cases.

The purpose of this multidisciplinary guideline is the identification of opportunities for efficacy and quality improvement in managing patient care and to fulfill the unmet need.