EPIstaxis Clinical Trials:
Advancing the Hospital Management of Acute Epistaxis
through National Collaborative Research
Epistaxis is the most common acute presentation to ENT services in the UK with around 25,000 cases each year. A recent national audit of epistaxis hospital management involving 1826 cases was delivered by INTEGRATE, the co-investigators of these proposed studies. This highlighted the healthcare burden associated with this condition with an average hospital length of stay of 29.5 hours and a representation rate of 13.9% across the dataset. The data also exposed a 30-day all-cause mortality rate of 3.4% which emphasised the illness severity of the patients we treat.
Prior to our involvement, there was no national consensus of how these patients should be managed. INTEGRATE conducted a wide-ranging set of systematic reviews across 5 management domains which revealed a paucity in high-level evidence to support current treatment strategies. These reviews were utilised to develop the ‘British Rhinological Society Multidisciplinary Consensus Recommendations on the Hospital Management of Epistaxis’ along an AGREE II framework for the generation of clinical guidelines. This now forms the new standard of care, however, when comparing this against current practice within our audit data, large variation was apparent. Multivariable analysis of our dataset, including the comparison of patients who did and did not conform to gold-standard care, has substantially added to our understanding of the condition. However, we have yet to add to the high-level evidence-base supporting epistaxis management.
We now seeks to develop a suite of 3 prospective clinical trials aimed to build from this current body of endeavour. INTEGRATE have succeeded in raising the national interest in collaborative research in our specialty, now is the time to capitalise on this momentum by looking to deliver higher level research for the benefit of our patients and the education of our research collaborators.