고령 환자에서 발생하는 재발성 비출혈의 특성과 위험요인에 대한 연구
Characteristics and Risk Factors of Recurrent Epistaxis in Geriatric Patients
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Background and Objectives Recurrent epistaxis requiring emergency department (ED)visits results in increased morbidity in the elderly and associated with high health care costs. This study is to analyze the frequency and characteristics of epistaxis patients in the elderlyand to find out the risk factors and effective treatment for recurrent epistaxis. Subjects and Method We studied retrospectively the clinical cases of 977 emergency patientsand 155 patients, aged over 65, for the treatment of epistaxis during the last 10 yearsfrom January 2008 to January 2018. The group A, comprised of 95 patients (68.29%), wastreated with an initial treatment. The group B, which comprised of 60 patients (38.71%), visitedfor re-bleeding following an initial treatment. Results Patients made 2 to 10 ED visits due to re-bleeding and 32 of the 60 patients (53.5%)visited twice. The electrocauterization was the most common (61.7%) for treatment methodduring rebleeding, followed by posterior packing (18.3%). The factors that increases the riskof recurrent epistaxis are anticoagulants, posterior epistaxis, anterior packing, inefficient EDpacking. There was no correlation between comorbidities and rebleeding. Conclusion Accurate medical history taking of anticoagulants may enable personnel to providemore effective management of these patients. The most important factors in the failure ofprimary care were not being able to find the precise area of bleeding and ineffective packingduring the initial treatment. Therefore, it is important that we must carefully check the areasusing the endoscope to decrease the failure of initial treatment of epistaxis.
Abstract
Background and Objectives Recurrent epistaxis requiring emergency department (ED)visits results in increased morbidity in the elderly and associated with high health care costs. This study is to analyze the frequency and characteristics of epistaxis patients in the elderlyand to find out the risk factors and effective treatment for recurrent epistaxis. Subjects and Method We studied retrospectively the clinical cases of 977 emergency patientsand 155 patients, aged over 65, for the treatment of epistaxis during the last 10 yearsfrom January 2008 to January 2018. The group A, comprised of 95 patients (68.29%), wastreated with an initial treatment. The group B, which comprised of 60 patients (38.71%), visitedfor re-bleeding following an initial treatment. Results Patients made 2 to 10 ED visits due to re-bleeding and 32 of the 60 patients (53.5%)visited twice. The electrocauterization was the most common (61.7%) for treatment methodduring rebleeding, followed by posterior packing (18.3%). The factors that increases the riskof recurrent epistaxis are anticoagulants, posterior epistaxis, anterior packing, inefficient EDpacking. There was no correlation between comorbidities and rebleeding. Conclusion Accurate medical history taking of anticoagulants may enable personnel to providemore effective management of these patients. The most important factors in the failure ofprimary care were not being able to find the precise area of bleeding and ineffective packingduring the initial treatment. Therefore, it is important that we must carefully check the areasusing the endoscope to decrease the failure of initial treatment of epistaxis.
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