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Re: Methodology Matters?

Dear Sir,

We reviewed Awan et al’s paper “Epistaxis: when are coagulation studies justified” today at our departmental journal club meeting. We had concerns over the vailidity of the concluions. We noted the following points:

It is not clear to us weather the 108 patients reviewed were admitted to hospital or simply presented to the emergency department. In the ‘Materials and Methods’section of the paper the autors state “charts of all patients aged >14 years with epistaxis requiring admission to the hospital…were reviewed”. Later in the ‘results’ section the authors write “108 patients ..presented to the emergency department with epistaxis”. Were these patients admitted as in-patients or did they simply present to the emergency department? We feel this terminology is important to clarify as admission for epistaxis implies greater severity or more complicated cases.

Secondly the methodology used by the authors to identify patients presenting with epistaxis is not clear. We are told that the charts of all patients >14 years with epistaxis were retrospectively reviewed but we are not told how these charts were identified. In almost 4 years 108 patients with epistaxis presenting (or being admitted) to a university hospital emergency department would seem from our experience to be a small cohort of patients for a university Emergency Department over 4 years. In our view this raises issues over the completeness of the review and how patients were identified.

We believe that the conclusions made by the authors are not substantiated by the methods and results.

Yours Sincerely,

Dr Mark Buckley