Trends in epistaxis embolization in the United States: A study of the nationwide inpatient sample 2003-2010 - Caveat emptor

摘要

Endovascular embolization for epistaxis is being used more frequently than it has in the past, and the procedure carries a small risk for stroke. These are the only conclusions that can be reliably drawn from the article by Brinjikji et al (1). Given the nature of the Nationwide Inpatient Sample (NIS) database and the design of this study, comparison of outcomes between embolization and surgical ligation is very limited. The data reported in this article, as presented, suggest that surgical ligation should be preferred over endovascular embolization, owing to a lower stroke rate, and this suggestion is extremely misleading. These data do not demonstrate the results of either a "ligation" or an embolization approach; rather, they show us the real-world results of cautery as a first-line treatment of refractory epistaxis and then transfer to another institution for embolization for treatment failures. Many of the patients in this database are likely the same people receiving both treatments and are counted twice.