Ein Jahr Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer HNO-Kliniken

Zusammenfassung

Hintergrund: Ziel war die Analyse der Versorgungsrealität der Behandlung der Epistaxis in der Notfallbehandlung in einer HNO-Klinik.

Material und Methoden: In den Ostthüringer HNO-Kliniken in Jena und Gera stellten sich im Jahr 2009 690 Patienten mit 862 Ereignissen einer Epistaxis vor (60% Männer, mittleres Alter: 60 Jahre). Die Charakteristika der Patienten wurden retrospektiv mit Blick auf die Komorbidität, Dauermedikation und Behandlungsmaßnahmen ausgewertet.

Ergebnisse: Die Inzidenz für die Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer Kliniken lag bei 121,28 pro 100 000 Einwohner Ostthüringens. Die häufigste Komorbidität war die Hypertonie (68% der Patienten). 27% der Patienten nahmen Thrombozytenaggregationshemmer und 19% Antikoagulantien ein. Als unabhängige Risikofaktoren für rezidivierende Epistaxis mit der Notwendigkeit einer erneuten Notfallbehandlung wurden die 3-fach Kombination antikoagulativer und Thrombozytenaggregations-hemmender Medikation (p=0,015), Morbus Osler (p=0,011) und Thrombozytopenie (p=0,009) identifiziert. Die angewendeten Therapiemaßnahmen in über 90% erfolgreich.

Schlussfolgerung: Die derzeitige HNO-Notfallbehandlung der Epistaxis in Notfallambulanzen von Kliniken erscheint effizient. Die Eskalation der antikoagulativen Dauermedikationen erhöht die stationäre Behandlungsnotwendigkeit. Weiterführende Analysen der Versorgungsrealität und Risikofaktoren sind notwendig, um eine Patientenstratifizierung im klinischen Alltag und Leitlinie zum Epistaxismanagement zu entwickeln.

Abstract

Objective: Aim of the study was to analyse the medical care situation of patients suffering from epistaxis in everyday clinical practice in ENT emergency departments.

Material and Methods: In the year 2009, 690 patients with 862 occurrences of epistaxis sought help in the 2 East Thuringian ENT emergency departments in Jena and Gera (60% male, average age: 60 years). The patients’ characteristics were evaluated retrospectively with a focus on comorbidity, long-term medication and treatment measures.

Results: The incidence of epistaxis treatment in the ENT emergency departments was 121 28 per 100 000 habitants of East Thuringia. Die Inzidenz für die Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer Kliniken lag bei 121 28 pro 100 000 Einwohner Ostthüringens The most common comorbidity was hypertension (68% of all patients). 27% of all patients were taking antiplatelet drugs and 19% anticoagulants. We identified the 3-fold combination of a medication with anticoagulant and antiplatelet drugs (p=0.015), Morbus Osler (p=0.011) and thrombocytopaenia (p=0.009) as independent risk factors for recurrent epistaxis. The therapeutic measures the patients led to success rates of more than 90%.

Conclusion: The actual ENT emergency treatment of epistaxis seems to be efficient. The escalation of anticoagulant long-term drug therapy has resulted in more admittance to the inpatient sector. More analyses of medical care situations and factors have to be carried out to develop a patient stratification for the daily clinical practice as well as a general guideline for the management of epistaxis.

Schlüsselwörter

Rhinologie - Nasenbluten - Versorgungsforschung - Risikofaktoren - Therapie

Key words

Rhinology - Nose bleeding - Health care research - risk factors - Therapy

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