Emergency consultation for epistaxis: A bad predictor for overall health?

OBJECTIVE: To compare the mortality rate of a large epistaxis cohort with the fatalities of the general Swiss population and to evaluate significant risk factors for impending early death.

METHODS: 568 patients out of an epistaxis cohort from a former study were contacted by mail to answer a questionnaire. Deceased patients were identified from March, 2007 through April, 2014. Death rates were compared to the general Swiss population. Different potential risk factors were evaluated by multivariate analysis.

RESULTS: Thirty-four percent of the included patients (61 of total n=181) died during the observation period. The mean number of deaths per year was 8.7. Binary logistic regression identified anterior localization (p=0.027), comorbid endogenous bleeding predisposition including hemorrhagic hereditary telangiectasia (p=0.017) and age (p<0.01) as independent and significant risk factors for early death in epistaxis patients. A significantly higher mortality was found within our epistaxis cohort compared to the Swiss general population.

CONCLUSION: With the present data a trivial event such as epistaxis, especially when anteriorly located, needs to be seen in a new light. Emergency consultation because of nose bleeding might be an unexpected bad predictor for mortality. Although conclusions need to be considered with caution due to the retrospective character of the study, we regard epistaxis as an independent alarm-signal. After an acute nose bleed requiring emergency consultation, active collaboration with the patient's general practitioner and additional efforts to check for the patient's general health might be more useful than so far assumed.