{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:08:07Z","timestamp":1790996887344,"version":"4.1.0"},"reference-count":20,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T00:00:00Z","timestamp":1514332800000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Laryngol. Otol."],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0022215117002018_sec_a1\"><jats:title>Objective:<\/jats:title><jats:p>Epistaxis is a common ENT emergency in the UK; however, despite the high incidence, there are currently no nationally accepted guidelines for its management. This paper seeks to recommend evidence-based best practice for the hospital management of epistaxis in adults.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215117002018_sec_a2\"><jats:title>Methods:<\/jats:title><jats:p>Recommendations were developed using an Appraisal of Guidelines for Research and Evaluation (\u2018AGREE II\u2019) framework. A multifaceted systematic review of the relevant literature was performed and a multidisciplinary consensus event held. Management recommendations were generated that linked the level of supporting evidence and a Grading of Recommendations Assessment, Development and Evaluation (\u2018GRADE\u2019) score explaining the strength of recommendation.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215117002018_sec_a3\"><jats:title>Recommendations:<\/jats:title><jats:p>Despite a paucity of high-level evidence, management recommendations were formed across five management domains (initial assessment, cautery, intranasal agents, haematological factors, and surgery and radiological intervention).<\/jats:p><\/jats:sec><jats:sec id=\"S0022215117002018_sec_a4\"><jats:title>Conclusion:<\/jats:title><jats:p>These consensus recommendations combine a wide-ranging review of the relevant literature with established and rigorous methods of guideline generation. Given the lack of high-level evidence supporting the recommendations, an element of caution should be used when implementing these findings.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0022215117002018","type":"journal-article","created":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T13:50:12Z","timestamp":1514382612000},"page":"1142-1156","source":"Crossref","is-referenced-by-count":39,"title":["The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis"],"prefix":"10.1017","volume":"131","author":[{"name":"INTEGRATE (The National ENT Trainee Research Network)","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2017,12,27]]},"reference":[{"key":"S0022215117002018_ref19","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13580"},{"key":"S0022215117002018_ref2","first-page":"1","article-title":"Epistaxis management: a multi-centre audit in England: is there a case for a national review of practice?","volume":"30","author":"Hall","year":"2015","journal-title":"J Laryngol Otol"},{"key":"S0022215117002018_ref10","doi-asserted-by":"crossref","unstructured":"Iqbal I , Jones HG , Dawe N , Mamais C , Smith ME , Williams RJ Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review. J Laryngol Otol. In press","DOI":"10.1017\/S0022215117002055"},{"key":"S0022215117002018_ref14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"S0022215117002018_ref18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2011.08753.x"},{"key":"S0022215117002018_ref13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"S0022215117002018_ref11","doi-asserted-by":"crossref","unstructured":"Khan M , Conroy K , Ubayasiri K , Constable J , Smith ME , Williams RJ Initial assessment in the management of adult epistaxis: systematic review. J Laryngol Otol. In press","DOI":"10.1017\/S0022215117002031"},{"key":"S0022215117002018_ref12","doi-asserted-by":"crossref","unstructured":"Swords C , Patel A , Smith ME , Williams RJ , Kuhn I , Hopkins C. Surgical and interventional radiological management of adult epistaxis: systematic review. J Laryngol Otol. In press","DOI":"10.1017\/S0022215117002079"},{"key":"S0022215117002018_ref9","doi-asserted-by":"crossref","unstructured":"Williams A , Biffen A , Pilkington N , Arrick L , Williams RJ , Smith ME Haematological factors in the management of adult epistaxis: systematic review. J Laryngol Otol. In press","DOI":"10.1017\/S0022215117002067"},{"key":"S0022215117002018_ref3","doi-asserted-by":"publisher","DOI":"10.1017\/S002221511700038X"},{"key":"S0022215117002018_ref8","doi-asserted-by":"crossref","unstructured":"Mcleod RW , Price A , Williams RJ , Smith ME , Smith M , Owens D. Intranasal cautery for the management of adult epistaxis: systematic review. J Laryngol Otol. In press","DOI":"10.1017\/S0022215117002043"},{"key":"S0022215117002018_ref17","volume-title":"Antithrombotics: Indications and Management","year":"2012"},{"key":"S0022215117002018_ref20","doi-asserted-by":"publisher","DOI":"10.1186\/cc12685"},{"key":"S0022215117002018_ref5","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090449"},{"key":"S0022215117002018_ref6","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2009.069013"},{"key":"S0022215117002018_ref4","unstructured":"INTEGRATE (National ENT Trainee Research Network). Epistaxis 2016: national audit of management. J Laryngol Otol. In press"},{"key":"S0022215117002018_ref7","volume-title":"The RAND\/UCLA Appropriateness Method User's Manual","author":"Fitch","year":"2001"},{"key":"S0022215117002018_ref15","unstructured":"The 2011 Oxford CEBM Levels of Evidence: Introductory Document. In: http:\/\/www.cebm.net\/index.aspx?o=5653 [16 June 2017]"},{"key":"S0022215117002018_ref1","unstructured":"NHS Hospital Episode Statistics in England and Wales. In: http:\/\/www.hesonline.nhs.uk [16 June 2017]"},{"key":"S0022215117002018_ref16","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"}],"container-title":["The Journal of Laryngology &amp; Otology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0022215117002018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T22:24:57Z","timestamp":1555367097000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0022215117002018\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12]]},"references-count":20,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2017,12]]}},"alternative-id":["S0022215117002018"],"URL":"https:\/\/doi.org\/10.1017\/s0022215117002018","relation":{},"ISSN":["0022-2151","1748-5460"],"issn-type":[{"value":"0022-2151","type":"print"},{"value":"1748-5460","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12]]}}}