Outpatient management of pediatric epistaxis: A cost analysis and clinical model.

Autor: Lee JA; Department of Otolaryngology-Head and Neck Surgery University of Illinois at Chicago College of Medicine Chicago Illinois USA., Puchi C; Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA., Billings KR; Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA.; Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA., Lavin JM; Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA.; Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA., Hazkani I; Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA.; Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA., Glennon C; Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA.; Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA., Thompson DM; Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA.; Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA., Maddalozzo J; Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA.; Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA.
Jazyk: angličtina
Zdroj: Laryngoscope investigative otolaryngology [Laryngoscope Investig Otolaryngol] 2024 Oct 08; Vol. 9 (5), pp. e1310. Date of Electronic Publication: 2024 Oct 08 (Print Publication: 2024).
DOI: 10.1002/lio2.1310
Abstrakt: Objectives: Pediatric epistaxis is a common, often non-operative condition encountered by Otolaryngologists. The present study seeks to (1) describe our outcomes of epistaxis management, (2) estimate the associated healthcare burden, and (3) propose a clinical model to optimize care coordination with primary care and advanced practice providers.
Methods: Retrospective case series of pediatric patients treated outpatient for epistaxis by a single otolaryngologist from 2021 to 2022. The primary outcome after treatment with nasal lubricants was defined as (1) refractory epistaxis, (2) improvement, or (3) complete resolution. Cost data for office versus operative nasal cautery were analyzed.
Results: In total, 122 patients were included for analysis. Over a follow-up duration of 20.5 months (IQR 8-36), 24.6% of patients experienced refractory epistaxis, 41.8% of patients found improvement, and 33.6% had complete resolution ( n  = 122). Refractory epistaxis was associated with a family history of coagulopathy ( p  = .007), daily epistaxis episodes ( p  = .043), and anemia ( p <.001). Average direct hospital costs associated with nasal cautery were $187 for in-office cauterization and $2179 for intraoperative cauterization. Estimated patient/third party payors savings were $1617 and $15,412 for in-office and intraoperative procedures, respectively, and $541.59 for specialty office visits alone. The average charge for laboratory work-up was $576.
Conclusion: Approximately 75% of patients with epistaxis experienced improvement or resolution of symptoms with nasal lubrication alone. Refractory epistaxis was associated with a family history of coagulopathy, daily epistaxis episodes, and anemia. Otolaryngology visits for epistaxis were associated with a direct healthcare expense burden. Adaptation of our clinical model may mitigate these costs while improving patient care. Level of Evidence : 4.
Competing Interests: The authors have no conflicts of interest or financial disclosures.
(© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)
Databáze: MEDLINE
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