Management paradigms for posterior epistaxis: A comparison of costs and complications

OBJECTIVES: Posterior epistaxis is a common otolaryngologic emergency. Mana gement is controversial because of the many treatment options available. Th ese options vary in efficacy, rates of complications, and cost. Posterior n asal packing is the medical management most frequently used to control post erior epistaxis. It is associated with major complications, including strok e, myocardial infarction, arrhythmias, and death. Because of these potentia l complications, many otolaryngologists monitor patients with posterior nas al packing in the intensive care unit (ICU). However, the level of care use d to monitor these patients is variable, and standards have not been establ ished. METHODS: From 1991 to 1997, 46 patients had posterior nasal packing placed to control epistaxis. Management, complications, and hospital charges were analyzed. RESULTS: Six patients (13%) were admitted to the ICU, 2 (4%) were admitted for telemetry monitoring, and 38 (83%) were sent to the ENT ward for contin uous pulse oximetry. Four major complications occurred (1 episode of syncop e (emergency department), 2 arrhythmias (ICU), and 1 death (hospice)). Twen ty-six patients were treated with posterior packing in the ENT ward, at a m ean cost of $2988, Fourteen patients underwent intervention (5 ligations, 6 endoscopic cauterizations, and 3 angiograms), with a mean cost of $5482. S ix patients spent time in the ICU, with a mean cost of $8242. Patients trea ted in the ENT ward had significantly lower costs than those undergoing int ervention (P = 0.017) or those admitted to the ICU (P = 0.020). CONCLUSION: We propose that most patients with posterior epistaxis can be t reated in specialized ENT wards. This can be done without increasing compli cations and with significantly decreased costs.