ENT Emergency Medicine Standard — AAO-HNSF 2020 / NICE CKS

EpiScore for Epistaxis Severity

Acute epistaxis is managed by assessment, first aid and escalation — the 'EpiScore' points total this page used is not a published instrument.

Used in: Epistaxis (Nosebleed)

Result

There is no validated points score for acute epistaxis — the 'EpiScore' this page used is not a published instrument. Assess airway, breathing and circulation first. First aid: sit forward, mouth open, and pinch the soft part of the nose firmly for 10–15 minutes without releasing (NICE CKS). If bleeding stops and a bleeding point is visible, consider cautery; if it continues, nasal packing and same-day ENT referral. Admit or refer urgently if haemodynamically unstable, bleeding is not controlled, a posterior source is suspected, or there is heavy blood loss. Check FBC, and clotting or INR if on an anticoagulant; group and save if bleeding is heavy. Unless the bleeding is life-threatening, start first-line treatment before transfusion or before reversing or stopping anticoagulant or antiplatelet drugs (AAO-HNSF 2020). For recurrent nosebleeds in hereditary haemorrhagic telangiectasia, use the HHT Epistaxis Severity Score.

References

Tunkel DE et al. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg. 2020.
NICE CKS. Epistaxis. 2023.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Epistaxis Severity Score (ESS) for HHT · Epistaxis

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

References

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