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Treatment disparities in the management of epistaxis in United States emergency departments.

Treatment disparities in the management of epistaxis in United States emergency departments.
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Sethi RKV, Kozin ED, Abt NB, Bergmark R, Gray ST,


Sethi RKV, Kozin ED, Abt NB, Bergmark R, Gray ST, (click to view)

Sethi RKV, Kozin ED, Abt NB, Bergmark R, Gray ST,

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The Laryngoscope 2017 07 08() doi 10.1002/lary.26683
Abstract
OBJECTIVES
There is limited data on epistaxis presentation and management patterns in U.S. emergency departments (EDs). We aim to characterize patients who present to the ED with epistaxis and identify factors associated with nasal-packing use.

STUDY DESIGN
Retrospective review of Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.

METHODS
NEDS was queried for patient visits with a primary diagnosis of epistaxis (International Classification of Diseases, Ninth Revision, Clinical Modification code 784.7). Patient demographics, comorbidities, and hospital characteristics were obtained. Predictors of nasal packing were determined by multivariable logistic regression.

RESULTS
There were 1,234,267 ED visits for epistaxis. The highest proportion of patients were seen in the winter (37.2%) at nontrauma hospitals (76.9%), and were discharged home (95.5%). Fifteen percent of patients were on long-term anticoagulation, 33% had hypertension, and 0.9% had a coagulopathy. Nasal packing was utilized in 243,268 patients (19.7%). Predictors strongly associated with nasal packing included lower socioeconomic quartile (odds ratio [OR] 1.30, 95% confidence interval [CI] = 1.10-1.53), hospital located in the geographic South (OR 1.62, CI = 1.12-2.34) and Midwest (OR 1.85, P < 0.0001), and nontrauma hospital (OR 1.56, CI = 1.19-2.05). Other factors included long-term anticoagulation (OR 1.21, CI = 1.10-1.33), winter season (OR 1.20, CI = 1.12-1.23), male gender (OR 1.14, CI = 1.10-1.17), and older age (OR 1.01, CI = 1.01-1.02). Mean ED charge was greater for patients who were packed ($1,473 vs. $1,048, P < 0.0001). CONCLUSION
Several factors, including lower socioeconomic status, geographic location, and nontrauma hospital designation, predict use of nasal packing. These results raise concerns about potential treatment disparities that may result in increased patient morbidity and costs.

LEVEL OF EVIDENCE
2C. Laryngoscope, 2017.

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