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Report by Angaj Ghosh, Senior Clinical Fellow Search checked by Rupert Jackson, Specialist Registrar
Clinical scenario
A child presents to the emergency department with a nosebleed that came on spontaneously and that has not responded to simple first aid measures. The bleed appears to be from the front of the nose and the patient has no underlying disease. You wonder whether silver nitrate cautery or application of nasal antiseptic cream is the best method of obtaining haemostasis.
Three part question
In [children with spontaneous epistaxis and no underlying disease] is [silver nitrate cautery better than nasal antiseptic cream] at [stopping bleeding and preventing recurrences]?
Search strategy
Medline 1966–12/00 using the OVID interface. {(exp epistaxis OR epistaxis.mp OR nosebleed$.mp) OR [(exp hemorrhage OR hemorrhage.mp OR haemorrhage.mp OR bleed$.mp) AND (exp nose OR nose.mp OR exp nasal mucosa OR nasal mucosa.mp OR nasal.mp OR nares.mp)]} AND (exp cautery OR cauter$.mp OR exp silver nitrate OR nasal cautery.mp OR exp anti-infective agents OR anti-infective agents.mp) LIMIT to human AND english.
Search outcome
Altogether 198 papers found of which 196 were irrelevant or of insufficient quality. The remaining two papers are shown in table 3.
Comments
This BET combines two patient groups—children with primary anterior epistaxis at first presentation and children with recurrent epitaxis. The final outcome being the same—stopping any further bleeds.
Clinical bottom line
Cautery and naseptin are equally effective. Given the ease of application naseptin is the treatment of choice.
Report by Angaj Ghosh, Senior Clinical Fellow Search checked by Rupert Jackson, Specialist Registrar