Use of tranexamic acid-soaked NasoPore® in the emergency department, to reduce epistaxis admissions.
emergency ORL
epistaxis
evidence-based medicine
health services research
outcomes
research
Journal
Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
ISSN: 1749-4486
Titre abrégé: Clin Otolaryngol
Pays: England
ID NLM: 101247023
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
revised:
25
07
2023
received:
15
11
2022
accepted:
03
08
2023
medline:
12
10
2023
pubmed:
24
8
2023
entrez:
24
8
2023
Statut:
ppublish
Résumé
The aim of this study was to assess the efficacy of a new emergency department (ED) intervention for the management of non-traumatic, anterior epistaxis in adult patients, aiming to reduce epistaxis admissions. A new epistaxis pathway was introduced for use by ED practitioners. This was disseminated in ED through an educational campaign by the ear, nose and throat team. A tranexamic acid (500 mg/5 mL)-soaked NasoPore® packing step was introduced for epistaxis which did not terminate following 10 min of simple first aid. The pathway was utilised for adult patients presenting with non-traumatic, anterior epistaxis. Pre- and post-implementation periods were defined, and all adults attending ED with non-traumatic, anterior epistaxis were included. Pre- and post-implementation epistaxis treatment interventions, admission rates and re-attendance rates were recorded by retrospective audit and compared. In the post-implementation group, epistaxis admissions were 51.7% (p < .05) lower than in the pre-implementation group, as a proportion of the total number attending ED with epistaxis during these periods. The significant reduction in epistaxis admissions demonstrates that this ED intervention is beneficial for patient outcomes.
Substances chimiques
Tranexamic Acid
6T84R30KC1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
909-914Informations de copyright
© 2023 John Wiley & Sons Ltd.
Références
INTEGRATE (The UK ENT Trainee Research Network). Admission avoidance in acute epistaxis: a prospective national audit during the initial peak of the COVID-19 pandemic. Clin Otolaryngol. 2021;46(3):577-586.
Eze N. Advice given to patients with epistaxis by A&E doctors. Emerg Med J. 2005;22(10):724-725.
National ENT Trainee Research Network. The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis. J Laryngol Otol. 2017;131(12):1142-1156.
National Institute for Health and Care Excellence. Clinical knowledge summaries: acute epistaxis. 2022 Available from: https://cks.nice.org.uk/topics/epistaxis-nosebleeds/management/acute-epistaxis/
Chiu TW, McGarry GW. Prospective clinical study of bleeding sites in idiopathic adult posterior epistaxis. Otolaryngol Head Neck Surg. 2007;137(3):390-393.
INTEGRATE (The UK ENT Trainee Research Network). Nasal packs for epistaxis: predictors of success. Clin Otolaryngol. 2020;45(5):659-666.
ENT UK. COVID-19 epistaxis management. 2020 Available from: http://orlcg.me/files/documents/0a48afd1-f0a7-4089-9097-c3ac1037b472.pdf
Iqbal IZ, Jones GH, Dawe N, Mamais C, Smith ME, Williams RJ, et al. Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review. J Laryngol Otol. 2017;131(12):1065-1092.
Gottlieb M, DeMott JM, Peksa GD. Topical tranexamic acid for the treatment of acute epistaxis: a systematic review and meta-analysis. Ann Pharmacother. 2019;53(6):652-657.
Joseph J, Martinez-Devesa P, Bellorini J, Burton MJ. Tranexamic acid for patients with nasal haemorrhage (epistaxis). Cochrane Database Syst Rev. 2018;2018(12):CD004328.
Richardson C, Abrol A, Hamill CS, Maronian N, Rodriguez K, D'Anza B. Improving efficiency in epistaxis transfers in a large health system: analyzing emergency department treatment variability as pretext for a clinical care pathway. Am J Otolaryngol. 2019;40(4):530-535.
Fishpool S, Tomkinson A. Patterns of hospital admission with epistaxis for 26,725 patients over an 18-year period in Wales, UK. Annals. 2012;94(8):559-562.
Goljo E, Dang R, Iloreta AM, Govindaraj S. Cost of management in epistaxis admission: impact of patient and hospital characteristics. Laryngoscope. 2015;125(12):2642-2647.
Ramagopalan SV, Wotton CJ, Handel AE, Yeates D, Goldacre MJ. Risk of venous thromboembolism in people admitted to hospital with selected immune-mediated diseases: record-linkage study. BMC Med. 2011;10(9):1.
Melin CM. Reducing falls in the inpatient hospital setting. Int J Evid Based Healthc. 2018;16(1):25-31.
Chen Y, Almirall-Sánchez A, Mockler D, Adrion E, Domínguez-Vivero C, Romero-Ortuño R. Hospital-associated deconditioning: not only physical, but also cognitive. Int J Geriatr Psychiatry. 2022;37(3):10.1002/gps.5687.
Saleem Z, Godman B, Hassali MA, Hashmi FK, Azhar F, Rehman IU. Point prevalence surveys of health-care-associated infections: a systematic review. Pathog Glob Health. 2019;113(4):191-205.
Oliver D. David Oliver: could we do better on hospital acquired covid-19 in a future wave? BMJ. 2021;372:n70.
Wang J, Cai C, Wang S. Merocel versus nasopore for nasal packing: a meta-analysis of randomized controlled trials. PloS One. 2014;9(4):e93959.
Hesham A, Ghali A. Rapid rhino versus merocel nasal packs in septal surgery. J Laryngol Otol. 2011;125(12):1244-1246.
Reschen ME, Bowen J, Novak A, Giles M, Singh S, Lasserson D, et al. Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions. BMC Emerg Med. 2021;21(1):143.
Yu J, Hammond G, Waken RJ, Fox D, Joynt Maddox KE. Changes in non-COVID-19 emergency department visits by acuity and insurance status during the COVID-19 pandemic. Health Aff. 2021;40(6):896-903.
Santi L, Golinelli D, Tampieri A, Farina G, Greco M, Rosa S, et al. Non-COVID-19 patients in times of pandemic: emergency department visits, hospitalizations and cause-specific mortality in Northern Italy. PloS One. 2021;16(3):e0248995.