Kryukov A.I., Plavunov N.F., Kadyshev V.A., Artemieva-Karelova A.V., Tovmasyan A.S., Kishinevskii A.E., Gorovaya E.V., Gunina M.V., Miroshnichenko S.A., Vershinina E.A., Tsarapkin G.Yu. Retrospective analysis of epidemiological indicators of epistaxis in general hospitals. Head and neck. Russian Journal. 2021;9(2):17–26 (In Russian).
The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.
Nasal bleeding (NB) is a pathological condition that threatens the patient’s life. This is a common condition in emergency otorhinolaryngology, occurring in 60% of the population. The simultaneous presence of several diseases in one patient (multimorbidity) becomes crucial to consider in the era of personalized approach in medicine. NB can be addressed not only as an independent condition, but also in combination with concomitant pathology. The study of the NB epidemiology does not lose its relevance, since the revealed patterns allow us to develop measures for effective management of hospitals that provide emergency assistance.
Purpose of the study: to establish the long-term epidemiological features of NB in the structure of otorhinolaryngological departments of general hospitals.
Material and methods. We studied the annual reports of the heads of ENT departments from 15 hospitals of the Moscow Healthcare Department, which provide assistance to the adult population, for the period from 2003 to 2019 (17 years). We analyzed admissions with NB and their annual dynamics. The following indicators were assessed in the reports: the number of patients treated in the otorhinolaryngology departments; the number of patients treated with a diagnosis of NB; the number of patients with NB who died; ratio and dynamics of these indicators. We performed the cumulative technical analysis of the data obtained with the determination of tendencies from the average values of the indicators, the graphical display of which is the trend line (TL), using Microsoft Office Excel software. The use of TL allowed to predict the future dynamics of the indicators. Each NB-related death was investigated from the deceased patient’s brief “information note”. The information on concomitant pathology (clinical diagnosis) in patients who died from NB in a hospital was studied, the multimorbidity index (the number of nosologies in the diagnosis in one patient) and the Charlson comorbidity index were calculated with and without relation to the age of the patients.
Results. During the observation period, 563189 patients were treated in the ENT departments of Moscow, 20623 (3.7%) patients were treated with NB. The average length of hospital stay was 1.04 bed-days. The trend values of prevalence and mortality are practically at the same level with the minimum multidirectional linear dynamics – 0.24% and + 0.04%, respectively. We observed an increase in the number of patients treated per year in otorhinolaryngological departments over the past 17 years by 58.5%. The increase in the absolute number of hospitalized patients with NB annually over the same period of time was 51.1%. We have identified 3 periods. From 2003 to 2010, the average growth rate of patients number per year was 3.3% (min 1.3% in 2004 and max 4.5% in 2007). From 2011 to 2015 — 0.5% (min 0.04% – 2013 and max 1.2% – 2011). From 2016 to 2019 — 6.4% (min 2.2% — 2016 and max 11.2% — 2019). The proportion of patients with NB during from the total number of treated patients was practically at the same level during the entire observation period, and on average was 3.7% (min 3.1% in 2016 and max 4% — 2008 and 2012). The mortality rate in the cohort of patients with NB was 0.25% (n = 52, of which 33 were men and 19 were women). The average age of the deceased was 64.7 years. Along with NB and post-hemorrhagic anemia, 17 other diseases / conditions appeared in clinical diagnoses (from 2 to 5 in each patient). The risk of death with NB remained at approximately the same level, with an average annual increase of 0.002% (according to approximation analysis). In patients who died from NB, the multimorbidity coefficient averaged 2.9±0.6 diseases / conditions, the comorbidity index – 5.74±1.12 points on the Charlson scale with considering patients age and 3.27±0.74 points without considering patients age (from 0 to 9 points). Diseases / conditions such as radiation and chemotherapy, pulmonary and cerebral edema, cachexia, coagulopathy, and pulmonary embolism were reported in 40 clinical diagnoses, but were not included in the Charlson score. Conclusion. When studying the prevalence of NB in the structure of ENT hospitals in Moscow, due to a large volume of statistical data, we managed to analyze not only absolute values and relative values, but also to determine trends characteristic of a given epidemiological process, the frequency of deaths, dynamics of death rates and indicators of multi- and comorbidity in this cohort of patients over a 17-year observation period. With the increasing number of patients treated with NB, the mortality rate in hospitals remained stable for 17 years, which is possible due to well-coordinated work and constant improvement of the provision of specialized medical care to these patients. Based on the trend analysis, it is possible to predict a further increase in the absolute number of patients with NB in ENT hospitals in Moscow. The deceased patients with NB belonged to the older age group with severe concomitant pathology and a high level of comorbidity. Perhaps, upon admission to the hospital, patients of the older age group with NB require a more thorough examination. The results of the study are of clinical significance and should be correlated with pathological data and data on the comorbidity of other groups of patients with NB in the future, to assess NB as a risk factor for long-term mortality.
Key words: nosebleeds, epidemiological process, epidemiology, mortality, emergency otorhinolaryngology, Moscow hospital, Charlson index, comorbidity, multimorbidity, hospitalization
Conflicts of interest. The authors have no conflicts of interest to declare.