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Multicenter Study
. 2020 Sep;45(5):659-666.
doi: 10.1111/coa.13555. Epub 2020 Jun 5.

Nasal Packs for Epistaxis: Predictors of Success

INTEGRATE (The UK ENT Trainee Research Network)
Collaborators
Multicenter Study

Nasal Packs for Epistaxis: Predictors of Success

INTEGRATE (The UK ENT Trainee Research Network). Clin Otolaryngol. 2020 Sep.

Abstract

Objectives: To investigate factors affecting the haemostatic success of non-dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED).

Design: Prospective cohort study.

Setting: A nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30-day period.

Participants: Patients 16 years or older, presenting to the ED with acute epistaxis managed with non-dissolvable intranasal packs.

Main outcome measures: The primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology.

Results: A cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter-duration packs (89.9% vs. 84.3%, χ2 P = .028). A patient survey supported longer packing duration. The most significant predictors of treatment failure were shorter packing duration (Odds Ratio (OR) = 2.3; 95% Confidence Interval (CI) = 1.4-3.8), alongside ischaemic heart disease (OR = 1.9; 95% CI = 1.1-3.3), normal admission haemoglobin (OR = 2.0; 95% CI = 1.2-3.4) and no attempt at cautery following pack removal (OR = 2.5; 95% CI = 1.4-4.2).

Conclusions: The majority of epistaxis patients are packed by the ED prior to referral to ENT. Once inserted, nasal packs are highly successful, with data supporting the British Rhinological Society guidance of maintaining nasal packs for around 24 hours. Further work is needed to explore alternatives to non-dissolvable intranasal packs to improve patient experience in epistaxis.

Keywords: Epistaxis; duration; nasal pack; rhinology.

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References

REFERENCES

    1. Petruson B, Rudin R. The frequency of epistaxis in a male population sample. Rhinology. 1975;13:129-133.
    1. INTEGRATE (National ENT Trainee Research Network). Epistaxis 2016: National audit of management. J Laryngol Otol. 2016;2017(131):1131-1141.
    1. National Institute for Health and Care Excellence. Clinical Knowledge Summaries. Epistaxis, n.d. https://cks.nice.org.uk/epistaxis-nosebleeds [2 August 2017].
    1. INTEGRATE (National ENT Trainee Research Network). The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis. J Laryngol Otol. 2017;131:1142-1156.
    1. Iqbal IZ, Jones GH, Dawe N, et al. Intranasal packs and haemostatic agents for the management of adult epistaxis: Systematic review. J Laryngol Otol. 2017;131:1065-1092.

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