Nosebleed (epistaxis): New clinical practice guideline

The American Academy of Otolaryngology-Head and Neck Surgery Foundation published the Clinical Practice Guideline: Nosebleed (Epistaxis) today in Otolaryngology-Head and Neck Surgery. A nosebleed is a common medical condition that occurs at some point in at least 60 percent of people in the United States.

"Although it is common, methods of diagnosis and treatment for nosebleed have not been uniformly used across clinicians and settings. To address that and to help reduce variations in care, this guideline provides evidence-based recommendations to improve quality of care," said David E. Tunkel, MD, Chair of the guideline development group (GDG).

A nosebleed is bleeding from the nostril, nasal cavity (inside of the nose), or nasopharynx (the part connecting the nose and throat). Nosebleed often happens without an obvious cause and occurs more often in children and the elderly, with three out of four children having a nosebleed at least once. A recent study based on data from the Nationwide Emergency Department Sample from 2009 to 2011 identified 1.2 million emergency department encounters for nosebleed.

Care for nosebleed ranges from self-treatment and home remedies to more intensive, procedural intervention in medical offices, emergency departments, hospitals, and operating rooms. This clinical practice guideline is designed for patients who cannot manage their nosebleeds through self-treatment and instead have bleeding that is severe enough to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that affects a person's quality of life.

"This is the first multidisciplinary, evidence-based guideline on nosebleed developed in the United States," said Dr. Tunkel. "It informs clinicians about the current level of evidence and includes areas of improvement of practice—such as providing patient instructions for nasal packing care—that were developed by the guideline panel after a review of all the literature."

The guideline delineates clear and actionable recommendations to implement quality improvement opportunities in clinical practice. The GDG used evidence-based research from five clinical practice guidelines, 17 systematic reviews, 16 randomized controlled trials, and 203 related studies to inform the Key Action Statements (KASs) for patient care.

The target patient for the guideline is any individual who is three years old or older with a nosebleed or history of nosebleed who needs medical treatment or who seeks medical care. The target audience for the guideline includes all clinicians who evaluate and treat patients with nosebleed.