Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis

Abstract

Objective To determine the demographics and seasonal and geographic variation of epistaxis in the United States. Study Design Retrospective cohort analysis based on data from Medicare claims. Setting Emergency department visits. Subjects and Methods We used a 5% sample of Medicare data from January 2012 to December 2012. Our cohort included patients with an incident diagnosis of epistaxis during a visit to the emergency department, excluding those with a diagnosis in the prior 12 months. Demographics included age, sex, race, and ethnicity. We compared the rate of emergency department visits for epistaxis by geographic division and individual states. Results In the 5% sample of Medicare data, 4120 emergency department visits for incident epistaxis were identified in 2012. Our results showed an increase in the emergency department visits for epistaxis with age. Compared with patients <65 years old, patients who were 66 to 76, 76 to 85, and >85 years old were 1.36 (95% confidence interval [95% CI], 1.23-1.50), 2.37 (95% CI, 2.14-2.62), and 3.24 (95% CI, 2.91-3.62) more likely to present with epistaxis, respectively. Men were 1.24 (95% CI, 1.17-1.32) times more likely to present with epistaxis than women. Blacks were 1.23 (95% CI, 1.10-1.36) times more likely to present with epistaxis when compared with non-Hispanic whites. Epistaxis emergency department visits were 40% lower in the summer months versus winter. The seasonal variation was more pronounced in the northern versus southern United States. Conclusion Emergency department visits for epistaxis increase with age and appear to be seasonal, with a more pronounced variation in the northern versus southern United States.

Factors influencing recurrent emergency department visits for epistaxis in the elderly

“…Two retrospective studies, Abrich et al [11] and Ando et al [12] that included included 461 and 299 patients, respectively, found that that accepted risk factors for initital epistaxis were not associated with recurrent epistaxis. In our previous study, we looked at risk factors associated with ED visits for new-onset epistaxis and found that older age, male gender, winter season and living in the northern U.S. were associated with an increased risk of an ED admission [6]. In this study, we found that most (~60%) of patients present to the ED with recurrent epistaxis within 30 days of their initial epistaxis event.…”

“…We chose only those records with ED visits for epistaxis and patients who had full coverage of Part A, Part B without enrollment in any health maintenance organization (HMO). We used our study cohort that in our previous study on incident epistaxis [6] which included 4120 patients. The cohort was then followed for an additional 12 months for recurrent epistaxis requiring another ED visit.…”

“…In a prior study [6], we identified several risk factors associated with increased rates of ED visits for new-onset epistaxis, including older age, male gender, winter season and living in the northern U.S. Presumed risk factors for initial epistaxis include facial trauma, hypertension, dryness of the nasal mucosa, physical and chemical irritation [7].…”

Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial

“…Episodes appear to be more common in those younger than 10 years, older than 70, and those exposed to dry indoor heating in the winter months (2). Whether a relationship exists between systemic hypertension and epistaxis, and whether that relationship implies causation or correlates with increased severity of bleeding, remains controversial (3-6).…”

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

“…Although prior studies have characterized demographic, seasonal, and geographic variation in epistaxis presentation throughout the United States, there is a limited understanding of contemporary management patterns in the ED setting . Indeed, as epistaxis management has evolved, so too has the landscape of emergency care.…”