EpiScore for Epistaxis Severity
Clinical scoring system for acute epistaxis to guide treatment escalation from simple first aid to intervention.
Score interpretation
Minor epistaxis. Likely anterior source (Little's area). Simple first-aid measures expected to be sufficient.
→ Pinch soft part of nose firmly for 10–15 min without releasing. Head forward. Ice pack to bridge. BIPP or silver nitrate cautery if source visible. Check anticoagulation levels. Advise: avoid blowing nose, sneezing through mouth, aspirin for 1 week.
Moderate epistaxis. May require formal ENT assessment and packing.
→ ENT review. Anterior nasal pack (merocel or Rapid Rhino). Check FBC, clotting, group and save. Review anticoagulation. BP management: antihypertensives if SBP ≥ 160. Remove pack at 48–72h.
Severe epistaxis. Likely posterior source. Risk of airway compromise / significant haemorrhage.
→ URGENT ENT / ENT on-call. IV access × 2. Resuscitation: IV fluids if haemodynamically compromised. Posterior pack (Brighton balloon / Foley catheter). Crossmatch. Consider examination under anaesthetic (EUA) / surgical ligation / interventional radiology embolisation. Reverse anticoagulation if needed.
Interpretation bands for the EpiScore. Apply clinical judgement and local guidance.
References
- Tunkel DE et al. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg. 2020.
- NICE CKS. Epistaxis. 2023.
Related
Curated clinical cross-links plus same-class fallbacks.
- Bivalirudin (PCI Anticoagulation) · Direct Thrombin Inhibitor / PCI
- Bivalirudin · Anticoagulation
- Tranexamic Acid 500mg Tablets (Epistaxis) · Antifibrinolytic agent (haemostatic)
- Silver Nitrate · Chemical Cautery — Epistaxis
- Naseptin Nasal Cream · Nasal Decolonisation / Recurrent Epistaxis
- Mifepristone and misoprostol (combination pack) · Anti-progestogen + prostaglandin (medical abortion)
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.