Treatment disparities in the management of epistaxis in United States emergency departments

Abstract

Objectives: There is limited data on epistaxis presentation and management patterns in U.S. emergency departments (EDs). We aim to characterize patients who present to the ED with epistaxis and identify factors associated with nasal-packing use.

Study design: Retrospective review of Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.

Methods: NEDS was queried for patient visits with a primary diagnosis of epistaxis (International Classification of Diseases, Ninth Revision, Clinical Modification code 784.7). Patient demographics, comorbidities, and hospital characteristics were obtained. Predictors of nasal packing were determined by multivariable logistic regression.

Results: There were 1,234,267 ED visits for epistaxis. The highest proportion of patients were seen in the winter (37.2%) at nontrauma hospitals (76.9%), and were discharged home (95.5%). Fifteen percent of patients were on long-term anticoagulation, 33% had hypertension, and 0.9% had a coagulopathy. Nasal packing was utilized in 243,268 patients (19.7%). Predictors strongly associated with nasal packing included lower socioeconomic quartile (odds ratio [OR] 1.30, 95% confidence interval [CI] = 1.10-1.53), hospital located in the geographic South (OR 1.62, CI = 1.12-2.34) and Midwest (OR 1.85, P < 0.0001), and nontrauma hospital (OR 1.56, CI = 1.19-2.05). Other factors included long-term anticoagulation (OR 1.21, CI = 1.10-1.33), winter season (OR 1.20, CI = 1.12-1.23), male gender (OR 1.14, CI = 1.10-1.17), and older age (OR 1.01, CI = 1.01-1.02). Mean ED charge was greater for patients who were packed ($1,473 vs. $1,048, P < 0.0001).

Conclusion: Several factors, including lower socioeconomic status, geographic location, and nontrauma hospital designation, predict use of nasal packing. These results raise concerns about potential treatment disparities that may result in increased patient morbidity and costs.

Level of evidence: 2C. Laryngoscope, 128:356-362, 2018.

Keywords: Epistaxis; anticoagulation; disparities; emergency department; nasal packing; socioeconomic status.