RESULTS
During a year, 36,686 cases were admitted to the PED. The presenting
complaint of 452 of these cases was epistaxis. The annual incidence of
our study was found 1.23% (123/10000).
The median age was 63 (minimum: 2 - maximum: 216) months and 258 of the
cases (57.1%) were male. It was found that the cases most frequently
applied to the hospital in autumn months (170, 37.6%). Sixty of the
patients (13.3%) had a chronic disease and 54 (11.9%) had a history of
drug use. Only four patients had a family history of bleeding diathesis.
Bleeding time was less than 5 minutes in 75.2% (286/380). Ninety-eight
(22.2%) patients had a previous epistaxis history and 84.4% (255/302)
of the bleeding was unilateral.
Epistaxis was due to local in 332 (73.4%) cases, systemic causes in 21
(4.7%) cases. The conditions that cause epistaxis are shown in Table 1.
In those with a history of trauma, the most common diagnosis was fall
with a rate of 59.6% (185/310).
The distribution of the conditions that cause epistaxis according to the
ages of the cases is given in Table 2. In the first 10 age group,
epistaxis was most frequently associated with trauma, and secondly, it
was found to be due to idiopathic causes. After the age of ten,
idiopathic causes were the most common cause of epistaxis. Epistaxis due
to systemic causes were not observed under the age of one year.
Physical examination revealed petechiae in four (0.9%) patients and
ecchymosis in 28 (6.2%) patients. There was no patient with
organomegaly or lymphadenopathy.
Laboratory tests and radiological imaging of the cases are presented in
Table 3. Two of the patients whose blood type was requested were from
high-energy trauma, one was the patient with a diagnosis of Immune
Thrombocytopenic Purpura (ITP) with low hemoglobin.
When the consultation rates to other clinics are examined; It was found
that consultations were made the Otorhinolaryngology (ENT) clinic at a
rate of 16.2% (73) from the PED and 9.3% (42) elective;
​Hematology-Oncology clinic at a rate of 2.4% (11) from the emergency
department and 1.8% (8) elective.
Three hundred and twenty-four (71.6%) of the cases did not do anything
before the hospital to stop the bleeding, 103 (22.8%) had done nasal
packing and 21 (4.6%) compression. In 434 (96%) of the patients,
epistaxis spontaneously stopped and there was no need for additional
treatment. Active bleeding were present in 14 (3.7%) patients at the
time of admission to the PED. In the PED, patients with active epistaxis
received 5 (1.1%) compression, 8 (1.8%) adrenaline cotton, 5 (1.1%)
tranexamic acid and 2 (0.4%) 75% silver nitrate cautery treatment was
applied.
It was found that complete blood count (CBC) was more frequent in
patients above the age of one and between the ages of 10-15, patients
with no history of trauma, chronic disease history and bilateral
bleeding, presenting with active bleeding and nasal bleeding due to
systemic causes (Table 4). When evaluated with logistic regression
analysis, it was found that the absence of only a history of trauma
among these factors increased the rate of CBC examination 11.8 times (Cl
95% 2.767-50.440).