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Nosebleeds Common But Seldom Serious, Study Finds

Most patients hospitalized for heavy bleeds need only minor treatment

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Almost everyone is able to treat their nosebleed themselves, or receive successful outpatient treatment at their doctor's office, an urgent-care clinic or an emergency room, the researchers said. Only 0.2 percent of nosebleeds require hospitalization, they said.

This study used nationwide data provided by hospitals to review the care provided to those hospitalized for a nosebleed. Researchers looked at more than 57,000 patients who were hospitalized for nosebleeds between 2008 and 2010. In all cases reviewed, the nosebleed had occurred spontaneously and for no apparent reason, Villwock said.

About 4.7 percent of patients underwent arterial ligation, a surgical procedure that ties off a blood vessel. Another 3.4 percent underwent embolization, in which a catheter delivers a sealant that closes off the bad blood vessel.

These treatments are both riskier and pricier, the researchers said. Embolization carries a five times greater risk of stroke than nasal packing, with 1.5 percent of people who underwent that procedure suffering a stroke. About 1.3 percent of people died while undergoing arterial ligation, a mortality rate nearly twice as high as that of nasal packing.

At the same time, people receiving embolization paid an average nearly $66,000 for their hospital stay, more than three times the amount charged to people treated with nasal packing. Despite this, embolization patients had average hospital stays about as long as people receiving other types of treatment for nosebleeds.

Although the study found an association between embolization treatment for nosebleed and an increased risk of stroke compared to other treatments, it did not establish a cause-and-effect relationship.

Dr. Richard Rosenfeld, chairman of otolaryngology with the SUNY Downstate Medical Center in New York City, praised the study. "This is the best sort of rocket fuel for evidence-based decisions and shared decision-making for treating [nosebleeds]. If I were a patient going into the hospital, I'd want to know these numbers. It could tip a little bit the way people make treatment decisions."

Of the hospitalized patients in the study, "these people are sick, sick pups. They have a lot of [other existing health conditions]," Rosenfeld said, including high blood pressure, alcoholism, kidney failure and lymphoma. "These data might not apply to the average healthy patient who comes in with a really bad nosebleed."

Rosenfeld said invasive treatments, although more risky, still were incredibly safe.

"Even for the most invasive treatments, most people did very well," he said. "Very few of them had poor outcomes."

Most people can handle their own nosebleeds by keeping their head parallel to the ground and applying a little ice and pressure, Villwock said.

"The rule is, if it hasn't stopped within 20 minutes, it's time to come in," she said.

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