Mobilisation of epistaxis patients - a prospective, randomised study documenting a safe patient care regime

Objective.  The project aimed at determining whether patients admitted to hospital for the treatment of epistaxis can be mobilised instead of the conventional regime of bed rest without increasing the risks of new bleeding episodes. Background.  A survey of nursing regimes for epistaxis patients has shown that patients were prescribed bed rest in 11 of 16 hospital departments. This prescription has been based on the assumption that bed rest reduces the risk of renewed bleeding. There is no scientific documentation of the need for bed rest demonstrating any reduced risks of new bleeding episodes. However, these patients are generally older and sustain an increased risk of further complications related to bed rest itself. Design.  The study was a prospective, randomised 1:1 parallel-group trial with 100 participants admitted to our department for the treatment of epistaxis. Methods.  Participants were randomly assigned to mobilisation or bed rest. Further, general demographic baseline data were registered including treatment modalities, hypertension, haemophilic disorders, anticoagulant therapy and diabetes. Results.  In the study group (mobilisation), 21 participants experienced new bleeding episodes against 29 maintaining haemostasis. In the control group (immobilisation), 24 participants experienced new bleeding episodes against 26. The odds ratio for bleeding when mobilised was 0·784 with a confidence interval of (0·356-1·728). Thus, there was no statistically significant evidence that mobilisation increased the risk of new bleeding episodes. Conclusion.  There was no statistical evidence to support the practice of bed rest to reduce the risk of renewed bleeding episodes in patients with primary epistaxis. This suggested that these patients can be mobilised without any increased risk of new haemorrhage. Relevance to clinical practice.  Mobilisation during hospital stay can maintain patients' levels of functionality, which will prevent both complications of bed rest and loss of self-esteem.