BACKGROUND Epistaxis is a common reason for emergency department (ED) visits, accounting for approximately 1 of every 200 ED visits in the United States annually and up to one-third of all otolaryngology (ENT)-related ED encounters. OBJECTIVES To detail reasons for ENT consultation for epistaxis in the ED, understand how consultation impacts patient care, assess follow-up patterns after emergency care, and study patient care after transfer or referral into the ED. METHODS Retrospective chart review of 592 adult patients with epistaxis managed in a tertiary care ED setting between 2017 and 2018. Patients with known follow-up, ENT consult in the ED, or admission were included, while patients with trauma, recent head and neck surgery, or abnormal anatomy were excluded. RESULTS The most common reasons for ENT consultation for epistaxis were for advanced management, referral to the ED from an outside facility or provider, and recent head and neck surgery. In total, 48.2% of patients treated for epistaxis in the ED received an ENT consultation. ENT consultation was associated with a higher likelihood of receiving absorbable or nonabsorbable packing (92.4% vs 36.1%). In total, 40.4% of patients referred into the ED from an outside facility or provider had no change in their management after receiving an ENT consult. Patients referred to the ED and White patients were significantly more likely to receive an ENT consult. Secondary analyses revealed that more White patients had an established outpatient ENT provider than patients of other races. On multivariate analysis, patients who received an ENT consult spent 75.2 min longer in the ED. CONCLUSION The high percentage of patients referred or transferred to the ED for epistaxis management with no change in interventions after ENT consultation indicates a continued need to develop more precise clinical care pathways. Additionally, there may be gaps between White and non-White patients in access to ENT care.

中文翻译：

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急诊室鼻出血的治疗、管理和耳鼻喉科咨询：机构经验。


背景技术鼻衄是急诊科(ED)就诊的常见原因，在美国每年每200例急诊科就诊中就有大约1例发生鼻出血，占所有耳鼻喉科(ENT)相关急诊科就诊人数的三分之一。目标 详细说明在急诊科就鼻出血进行耳鼻喉科会诊的原因，了解会诊如何影响患者护理，评估急诊护理后的随访模式，并研究转诊或转诊至急诊科后的患者护理。方法 对 2017 年至 2018 年间在三级护理急诊室接受治疗的 592 名鼻出血成人患者进行回顾性图表审查。包括已知随访情况、在急诊科进行耳鼻喉科会诊或入院的患者，以及患有外伤、近期头颈部手术的患者，或排除异常的解剖结构。结果 因鼻出血而进行耳鼻喉科会诊的最常见原因是先进的治疗、从外部机构或提供者转诊至急诊室以及最近进行过头颈手术。总共有 48.2% 在急诊室接受鼻出血治疗的患者接受了耳鼻喉科会诊。耳鼻喉科会诊与接受可吸收或不可吸收填塞的可能性较高相关（92.4% vs 36.1%）。总共有 40.4% 的从外部机构或提供者转诊至急诊室的患者在接受耳鼻喉科会诊后，其管理没有发生变化。转诊至急诊室的患者和白人患者接受耳鼻喉科咨询的可能性明显更大。二次分析显示，与其他种族的患者相比，更多的白人患者有固定的耳鼻喉科门诊服务提供者。多变量分析显示，接受耳鼻喉科会诊的患者在急诊室的停留时间延长了 75.2 分钟。 结论 在耳鼻喉科会诊后转诊或转至急诊科进行鼻衄治疗且干预措施没有变化的患者比例很高，这表明仍然需要开发更精确的临床护理途径。此外，白人和非白人患者在获得耳鼻喉科护理方面可能存在差距。