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Epistaxis management at Guy's Hospital, 2009–2011: full audit cycles

  • A C Hall (a1), M Simons (a1), G Pilgrim (a1), C Theokli (a1), D Roberts (a1) and C Hopkins (a1)...



To assess management of epistaxis at a tertiary ENT referral hospital against a recently published standard of best practice.


Fifty consecutive cases of acute epistaxis that required admission to Guy's Hospital in 2009 were evaluated. Epistaxis education sessions were held to introduce our algorithm of best practice in tandem with an emphasis on emergency department care. Similar retrospective reviews were carried out in both 2010 and 2011 (on groups of 50 patients).

Results and conclusion:

The first audit cycle demonstrated that only 8 per cent of patients underwent a suitable nasal examination in the emergency department prior to transfer, with no documented attempts at nasal cautery. Surgical intervention procedures were performed on only 40 per cent of eligible patients. The audit cycles that followed the introduction of the epistaxis algorithm demonstrated continued improvement in initial evaluation and management of epistaxis. In select patients, sphenopalatine artery ligation can provide timely, definitive management of refractory epistaxis.


Corresponding author

Address for correspondence: Miss C Hopkins, Department of Otolaryngology, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK Fax: 0207 188 2212 E-mail:


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Presented orally at the Clinical Audit and Practice Advisory Group Annual Meeting, 8 September 2011, London, UK.



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1NHS Hospital Episode Statistics in England and Wales 2009–2010. In: [18 February 2013]
2Horrocks, M, Cripps, J. EWTD 2009 – meeting the challenge in surgery. Ann R Coll Surg Engl 2008;90(suppl 2):80–1
3Kotecha, B, Fowler, S, Harkness, P, Walmsley, J, Brown, P, Topham, J. Management of epistaxis: a national survey. Ann R Coll Surg Engl 1996;78:444–6
4Melia, C, McGarry, GW. Epistaxis: update on management. Curr Opin Otolaryngol Head Neck Surg 2011;19:30–5
5Schlosser, RJ. Clinical practice. Epistaxis. N Engl J Med 2009;360:784–9
6Daudia, A, Jaiswal, V, Jones, N. Guidelines for the management of idiopathic epistaxis in adults: how we do it. Clin Otolaryngol 2008;33:618–20
7Biswas, B, Rafferty, A, Jassar, P. Night emergency cover for ENT in England: a national survey. J Laryngol Otol 2009;123:899902
8Kumar, S, Shetty, A, Rockey, J, Nilssen, E. Contemporary surgical treatment of epistaxis: what is the evidence for sphenopalatine artery ligation? Clin Otolaryngol 2003;28:360–3
9Moshaver, A, Harris, JR, Liu, R, Diamond, C, Seikaly, H. Early operative intervention versus conventional treatment in epistaxis: randomised prospective trial. J Otolaryngol 2004;33:185–8
10Douglas, R, Wormald, PJ. Update on epistaxis. Curr Opin Otolaryngol Head Neck Surg 2007;15:180–5



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