{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:58:48Z","timestamp":1785405528813,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010731","name":"Faculty of Medicine, Chiang Mai University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010731","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/05m2fqn25","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Epistaxis is a common emergency department (ED) presentation, but the prognostic significance of triage blood pressure (BP) remains unclear. We evaluated whether elevated systolic BP (SBP) at ED arrival was associated with delayed bleeding cessation in adults with non-traumatic epistaxis. Methods: We conducted a retrospective cohort study of adults (\u226518 years) presenting with non-traumatic epistaxis to a tertiary ED in Northern Thailand between 2015 and 2025. Patients with documented triage SBP were included (n = 482). The exposure was SBP at ED arrival, categorized as \u2265140 versus &lt;140 mmHg. The primary outcome was time from ED arrival to first documented bleeding cessation. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards regression, controlling for demographics, comorbidities, medication use, and ED interventions. Results: Among 482 patients, 310 (64.3%) had SBP \u2265 140 mmHg. Median time to documented bleeding cessation was longer in patients with elevated SBP than in those with SBP &lt; 140 mmHg (39 vs. 23 min). In adjusted analyses, SBP \u2265 140 mmHg was associated with delayed documented bleeding cessation (aHR, 0.71; 95% CI, 0.52\u20130.98). Mechanical nasal packing was also associated with slower bleeding control (aHR, 0.72; 95% CI, 0.54\u20130.95), whereas electrical cauterization was associated with faster cessation (aHR, 2.17; 95% CI, 1.19\u20133.96). Conclusions: Elevated SBP at ED arrival was associated with prolonged time to documented bleeding cessation in non-traumatic epistaxis. Triage SBP may serve as a pragmatic early prognostic marker of prolonged ED management. However, important bleeding severity characteristics, including bleeding location and estimated blood loss, were unavailable, and residual confounding cannot be excluded. These findings should not be interpreted as evidence supporting acute antihypertensive therapy to accelerate hemostasis. Prospective studies are needed to validate these findings.<\/jats:p>","DOI":"10.3390\/jcm15145535","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:29:39Z","timestamp":1784100579000},"page":"5535","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Systolic Blood Pressure at Emergency Department Arrival and Time to Bleeding Cessation in Adult Non-Traumatic Epistaxis: A Retrospective Time-to-Event Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Phawinee","family":"Phiromkanchanasak","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suwijahk","family":"Chaiphrom","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhumsapanan","family":"Thiamkaew","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wannagon","family":"Thanadolyothin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1418-0036","authenticated-orcid":false,"given":"Wachira","family":"Wongtanasarasin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Acute Care and Emergency Medicine (ACE) Research Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1177\/19458924231223348","article-title":"Treatment, Management, and Otolaryngology Consultation for Epistaxis in the Emergency Room: An Institutional Experience","volume":"38","author":"Jacobs","year":"2024","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/0194599816667295","article-title":"Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis","volume":"156","author":"Chaaban","year":"2017","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1001\/jamaoto.2020.2906","article-title":"Association of Hypertension with the Risk and Severity of Epistaxis","volume":"147","author":"Byun","year":"2020","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_4","first-page":"1455613231189056","article-title":"Risk Factors for Severe Clinical Course in Epistaxis Patients","volume":"105","author":"Hadar","year":"2023","journal-title":"Ear Nose Throat J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1177\/19458924241308952","article-title":"Surgical Management of Moderate to Severe Epistaxis in Hereditary Hemorrhagic Telangiectasia: Systematic Review and Meta-Analysis","volume":"39","author":"Benaim","year":"2025","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1177\/0194599817721445","article-title":"Association between Hypertension and Epistaxis: Systematic Review and Meta-Analysis","volume":"157","author":"Min","year":"2017","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jsha.2014.09.002","article-title":"Relationship between Epistaxis and Hypertension: A Cause and Effect or Coincidence?","volume":"27","author":"Sarhan","year":"2015","journal-title":"J. Saudi Heart Assoc."},{"key":"ref_8","first-page":"e86722","article-title":"The Relationship Between Epistaxis and Stages of Hypertension: A Prospective Observational Study of 250 Cases in Emergency Medicine","volume":"17","author":"Aggarwal","year":"2025","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s00405-013-2450-z","article-title":"Is Epistaxis Associated with Arterial Hypertension? A Systematic Review of the Literature","volume":"271","author":"Kikidis","year":"2014","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1053\/ajem.2002.31577","article-title":"Active Epistaxis at ED Presentation Is Associated with Arterial Hypertension","volume":"20","author":"Herkner","year":"2002","journal-title":"Am. J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jash.2012.05.001","article-title":"Relationship between Blood Pressure and Persistent Epistaxis at the Emergency Department: A Retrospective Study","volume":"6","author":"Terakura","year":"2012","journal-title":"J. Am. Soc. Hypertens."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1016\/j.ajem.2019.10.025","article-title":"Is Epistaxis Associated with High Blood Pressure and Hypertension? Propensity Score Matching Study","volume":"38","author":"Kim","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.bjorl.2016.01.007","article-title":"A Possible Cause of Epistaxis: Increased Masked Hypertension Prevalence in Patients with Epistaxis","volume":"83","author":"Acar","year":"2017","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s40292-024-00669-7","article-title":"Epistaxis and Clinic Blood Pressure Values: Is There a Relationship?","volume":"31","author":"Modesti","year":"2024","journal-title":"High Blood Press. Cardiovasc. Prev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1213\/ANE.0000000000003653","article-title":"Survival Analysis and Interpretation of Time-to-Event Data: The Tortoise and the Hare","volume":"127","author":"Schober","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Salika, T., Turner, R.M., Fisher, D., Tierney, J.F., and White, I.R. (2022). Implications of Analysing Time-to-Event Outcomes as Binary in Meta-Analysis: Empirical Evidence from the Cochrane Database of Systematic Reviews. BMC Med. Res. Methodol., 22.","DOI":"10.1186\/s12874-022-01541-9"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"499","DOI":"10.2307\/2531021","article-title":"Sample-Size Formula for the Proportional-Hazards Regression Model","volume":"39","author":"Schoenfeld","year":"1983","journal-title":"Biometrics"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Walther, L.-M., and Wirtz, P.H. (2023). Physiological Reactivity to Acute Mental Stress in Essential Hypertension-a Systematic Review. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1215710"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"101442","DOI":"10.1016\/j.eclinm.2022.101442","article-title":"Variability Independent of Mean Blood Pressure as a Real-World Measure of Cardiovascular Risk","volume":"48","author":"Ebinger","year":"2022","journal-title":"eClinicalMedicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/HYPERTENSIONAHA.123.22570","article-title":"Intraoperative Blood Pressure Misclassification Due to Inaccuracy of Noninvasive Oscillometric Cuff-Measured Blood Pressure","volume":"82","author":"Kim","year":"2025","journal-title":"Hypertension"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"596","DOI":"10.5603\/CJ.a2023.0026","article-title":"The Importance of Blood Pressure Measurements at the Emergency Department in Detection of Arterial Hypertension","volume":"31","author":"Szypenbejl","year":"2024","journal-title":"Cardiol. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"189","DOI":"10.15441\/ceem.18.022","article-title":"Emergency Department and Hospital Crowding: Causes, Consequences, and Cures","volume":"6","author":"McKenna","year":"2019","journal-title":"Clin. Exp. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Belayneh, A.G., Temachu, Y.Z., Messelu, M.A., and Gebrie, M.H. (2023). Prolonged Length of Stay and Its Associated Factors at Adult Emergency Department in Amhara Region Comprehensive Specialized Hospitals, Northwest Ethiopia. BMC Emerg. Med., 23.","DOI":"10.1186\/s12873-023-00804-y"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Samadbeik, M., Staib, A., Boyle, J., Khanna, S., Bosley, E., Bodnar, D., Lind, J., Austin, J.A., Tanner, S., and Meshkat, Y. (2024). Patient Flow in Emergency Departments: A Comprehensive Umbrella Review of Solutions and Challenges across the Health System. BMC Health Serv. Res., 24.","DOI":"10.1186\/s12913-024-10725-6"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5675","DOI":"10.1007\/s00464-020-08256-2","article-title":"Controlled Hypertension under Hemostasis Prevents Post-Gastric Endoscopic Submucosal Dissection Bleeding: A Prospective Randomized Controlled Trial","volume":"35","author":"Lin","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"8885","DOI":"10.2174\/0109298673324637240930140545","article-title":"Thrombosis in Hypertension: Pathophysiology, Biomarkers, and the Effect of Antihypertensive Treatment","volume":"32","author":"Theofilis","year":"2024","journal-title":"Curr. Med. Chem."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"37760","DOI":"10.51894\/001c.37760","article-title":"Risk Factors and Management for Epistaxis in a Hospitalized Adult Sample","volume":"7","author":"Ross","year":"2022","journal-title":"Spartan Med. Res. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e020999","DOI":"10.1161\/JAHA.121.020999","article-title":"Blood Pressure and Cardiovascular Disease in Older Patients With Diabetes: Retrospective Cohort Study","volume":"10","author":"Hong","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"527","DOI":"10.2147\/OAEM.S247017","article-title":"Nasal Packing in the Emergency Department: A Practical Review for Emergency Providers","volume":"13","author":"Tran","year":"2021","journal-title":"Open Access Emerg. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5535\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:19:48Z","timestamp":1784261988000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5535"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":29,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145535"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145535","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]}}}