Nosebleed Severity Score (ESS)

Nosebleed Severity Score (ESS)

The Epistaxis Severity Score (ESS)* is an online tool used to evaluate the current severity of HHT patient nosebleeds (typically in the last three months) and can help health care providers to evaluate how a patient is responding to treatment. This score ranges from 0-10 and is automatically calculated after answering six simple questions.

*Dr. Hoag was able to conduct this research and develop the ESS through a Cure HHT grant award. He presented an abstract outlining the results of his study at the 8th HHT International Scientific Conference.

Treatment for epistaxis should be determined by a care provider with experience treating HHT patients and this calculation should serve to assist their clinical evaluation. A patient's ESS can help doctors evaluate the most effective treatment for HHT-related nosebleeds.

Nosebleed Severity Score Chart

A change in your ESS might mean that you should consult your doctor about that state of your nosebleeds and potentially have a conversation about your current epistaxis treatment regimen. A recent study was done in 2015 to determine what kind of change in your ESS is considered significant.

This 2015 abstract published in Laryngoscope entitled, "The minimal important difference of the epistaxis severity score in Hereditary Hemorrhagic Telangiectasia", describes a study that determined the smallest change in a person’s Epistaxis Severity Score that would be considered a significant change. This value, called the minimal important difference (MID), was determined to be 0.71 (Yin et al. 2015). The MID is important for monitoring the progression of a patient’s HHT symptoms and helps to determine the best course of treatment. This would mean that if your ESS has increased by at least 0.71 that your nosebleeds have significantly increased in severity and could mean that the current treatment or therapy is not effective for you. On the other hand, if your score has decreased by at least 0.71 then your nosebleeds have significantly decreased in severity, and this might mean that your current epistaxis treatments are working well for you and should be continued.