Factors Associated with Recurrent Emergency Department Visits for Epistaxis in Adults, Cross Sectional Study in Two Tertiary Care Hospitals in Riyadh, Saudi Arabia

Mohammed Alghofili,1 Bader Alwhaibi,2 Abdullah Mohammed Alassaf,2 Omar Wahaf Aldhasee,3 Nawfal Aljerian,3 Nawaf Alsubaie,4 Ahmed Alhussien,4 Saad Alsaleh4 1Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3Department of Emergency Medical Services, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; 4Otolaryngology – Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Ahmed Alhussien, Otolaryngology – Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia, King Saud University, P.O Box 245, Riyadh, 11411, Tel +4786100 ext. 3401 ; +966560255444, Email [email protected] and Objectives: This study aimed to investigate the prevalence of recurrent and active epistaxis in adult patients presenting to the Emergency Department (ED) and explored the association of recurrent epistaxis with demographic characteristics, comorbidities and medications, and types of emergency interventions in adult epistaxis patients.Methods: A retrospective cross-sectional study was conducted with data from Eds of two tertiary hospitals over three years, from January 2019 to January 2022. All adult patients aged ≥ 18 years with active epistaxis not resolved by pressure on the nose or head positioning were included. Demographic data, details of clinical presentation and clinical management were collected from the patient’s electronic medical records.Results: Of 404 patients, 73 (18.1%) revisited the ED with recurrence of epistaxis within 28 days. There was a male predilection in the study, with an average age of 55.4 ± 18.03. Most patients had unilateral (n = 328, 81.2%) and anterior (n = 376, 93.1%) nasal bleeding. Heart failure as a comorbidity was associated with a significantly increased risk of recurrent epistaxis (p = 0.001). The most common treatments included expandable polyvinyl acetate packs (EPAP) (n = 198, 49%); topical xylometazoline (n = 108, 26.7%); and chemical cautery (n = 57, 14.1%). EPAP for controlling initial bleeding was significantly associated with ED revisits due to epistaxis (p = 0.033).Conclusion: The prevalence of recurrent epistaxis mostly occurs in older-aged males. Congestive heart failure may be an under-recognised risk factor for recurrent epistaxis. In patients with a high risk of epistaxis recurrence, other treatment modalities should be sought aside from expandable polyvinyl acetate packs as they can increase the risk of rebleeding.Keywords: epistaxis, recurrence, risk factors, comorbidity