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Multicenter Study
. 2021 May;46(3):577-586.
doi: 10.1111/coa.13716. Epub 2021 Feb 4.

Admission avoidance in acute epistaxis: A prospective national audit during the initial peak of the COVID-19 pandemic

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

Admission avoidance in acute epistaxis: A prospective national audit during the initial peak of the COVID-19 pandemic

INTEGRATE (The UK ENT Trainee Research Network). Clin Otolaryngol. 2021 May.

Abstract

Objectives: To report changes in practice brought about by COVID-19 and the implementation of new guidelines, and to explore factors relating to unscheduled re-presentations for patients discharged from the emergency department (ED).

Design: Prospective multicentre national audit over 12 weeks from 6th April 2020.

Setting: UK secondary care ENT departments.

Participants: Adult patients with acute epistaxis.

Main outcome measures: Re-presentation within 10 days for patients discharged from the ED.

Results: Eighty three centres from all four UK nations submitted 2631 valid cases. The majority of cases were ED referrals (89.7%, n = 2358/2631). 54.6% were discharged from the ED following ENT review (n = 1267/2322), of whom 19.5% re-presented within 10 days (n = 245/1259) and 6.8% were ultimately admitted (n = 86/1259). 46.7% of patients had a non-dissolvable pack inserted by ED prior to referral to ENT (n = 1099/2355). The discharge rates for ED patients and their subsequent re-presentation rates were as follows: non-dissolvable packs, 29.5% discharged (n = 332/1125), 18.2% re-presented (n = 60/330); dissolvable products, 71.1% discharged (n = 488/686), 21.8% re-presented (n = 106/486); cautery only, 89.2% discharged (n = 247/277), 20.0% re-presented (n = 49/245); and no intranasal intervention, 85.5% discharged (n = 200/234), 15.2% re-presented (n = 30/198). Univariable logistic regression showed that not being packed by ED, antiplatelet medications, failed cautery and recent epistaxis treatment were significant predictors of re-presentation within 10 days.

Conclusions: Management of acute epistaxis was notably affected during the initial peak of the pandemic, with a shift towards reduced admissions. This national audit highlights that many patients who may previously have been admitted to hospital may be safely discharged from the ED following acute epistaxis.

Keywords: ambulatory; discharge; multicentre; observational; outpatient.

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References

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