Epidemiological factors and routing features of patients with spontaneous nosebleeds

At the stage of emergency medical care (EMC) the nosebleeds (NB) not connected with trauma are considered spontaneous. Since previous works have studied the prevalence of NB only at the hospital stage, some issues of NB epidemiology need to be clarified Objective. To study the prevalence of spontaneous nosebleeds (NB) in the structure of emergency medical care in Moscow and to characterize the dynamics of the epidemiological process and the routing features of this patient based on the data obtained. Material and methods. A statistical analysis of the ambulance field teams’ work in the medical care provision to patients with NB was carried out. Exclusion criteria from the study: patients needed the emergency psychiatric care; patients with chronic renal failure accompanied by EMC teams for outpatient hemodialysis; pediatric patients; NB of traumatic genesis. The observation period was 6 years (2015—2020). One of the statistical analysis was singular spectral analysis (SSA). Results. For 6 years, the ambulance team made 24 160 701 calls to patients. Patients with spontaneous bleeding (SB) accounted for 1.1% (262 503), with NB — 0.3% (n=73 202). In the insurance company structure, the share of NB amounted to 27.9%. The proportion of medical evacuation of patients with NB is 30.5%, with other SB — 84.3%. Repeated calls of ambulance teams to patients with NB vary from 7% to 10.4% while the 6-year trend is characterized by a decrease of 0.9%. The proportion of patients with NB who required medical evacuation to multidisciplinary hospitals is decreasing by 5.4% annually. As a result of the SSA it was found that the dynamics of the prevalence of nosebleeds in the structure of EMC is characterized by constantly growing trend with a median annual increase by 12.5% [12; 14.5]. After studying the epidemiology dynamics of nosebleeds, the seasonal pattern was established. The increase in the number of nosebleeds in the winter (December and January months) and the decline — in the summer (July). The seasonal value extremes of Меmax =1432.5 [1182; 1698] and Меmin =672 [610; 720] people in the summer and winter seasons, respectively, were established. During the 6-year follow — up period an ever-increasing number of patients with nosebleeds was recorded at seasonal extremes: in winter by 89%, in summer — by 37.3%. Conclusion. Trend analysis and SSA can be the first step to identify the more complex mathematical patterns for medical data that are varying over time. © 2021, Media Sphera Publishing Group. All rights reserved.

Plavunov N.F. 1, 2 , Tsarapkin G.Yu.3 , Kadyshev V.A. 1, 2 , Sidorov A.M.2 , Khokhlov A.A. 4 , Gorovaya E.V.3 , Kishinevsky A.E.3 , Smirnova E.N. 3 , Gunina M.V.5
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  • 1 A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
  • 2 A.S. Puchkov Station of the first and emergency medical care, Moscow, Russian Federation
  • 3 L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russian Federation
  • 4 Peoples’ Friendship University of Russia, Moscow, Russian Federation
  • 5 F.I. Inozemtsev Municipal Clinical Hospital, Moscow, Russian Federation
Emergency medical care; Epidemiology; Nosebleeds; Seasonality; Singular spectral analysis; Spontaneous bleeding; Trend analysis
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