Non surgical management of epistaxis in elderly patients who presented to emergency department: a systematic review

Abstract

Epistaxis is one of the most common diseases that accounts for about half persent of emergency patients and 60% of people experience epistaxis at least once in their lifetime. Epistaxis bleeding can be divided into 2 categories, anterior bleeding and posterior bleeding, based on the place where the bleeding occurs; more than 90% of bleedings occur anteriorly. posterior bleeding that mostly occurs in the posterior nasal cavity,is often has the artrial origins. The causes of epistaxis can be divided into local causes, systemic causes, and idiopathic causes. Local trauma to the nose is the most common cause. Recommended measures to control and treat epistaxis include surgical and non-surgical measures. Considering the importance of epistaxis in the elderly, which can be life-threatening, and the lack of a single treatment guideline for this category of patients, we were motivated to conduct a systematic study of the studies conducted in this field, so that if possible, we can reach a unified approach in treatment. Non-surgical treatment of epistaxis in the elderly. Method: A systematic search of sources was conducted in order to non surgical management of epistaxis in elderly patients who presented to emergency department was performed for meta-analysis and systematic review. The extracted studies were independently screened by two researchers based on the PRISMA statement. Data extraction from the entered studies was done using a data extraction table designed based on the objectives by one researcher and random evaluation by another researcher. Meta-analysis was used to review treatment methods. A p-value less than 5 percent was considered as a significant level. Results: In the systematic search of sources, 28 studies were included in this meta-analysis. According to the reports mentioned in 24 articles, the average age of the studied subjects is 68.13 years. On average, 56.6% were men and 43.4% were women. The average rate of rebleeding in 18 studies was 18.8%. Regarding risk factors in treatment methods, 35.7% from nasal packing and 14.3% from intranasal topical tranexamic acid were extracted from these studies. And 10.7% have used silver nitrate and 10.7% have used Floseal treatment.