Risk of Re-bleeding In The Packed Epistaxis Patient: A Pilot Study To
Inform Potential Outpatient Management.
Background: Epistaxis management frequently includes the insertion of a
non-absorbable nasal pack, and patients may often be admitted during
this treatment. During the recent COVID-19 pandemic, UK guidance to
discharge “suitable” patients, with pack in-situ, was published in
order to minimise hospital admissions and viral nosocomial transmission.
Evidence which defines patient suitability for discharge, however, is
lacking. Method: The medical records of 100 patients admitted for
idiopathic epistaxis in our trust, managed with non-absorbable packing,
were analysed. We sought to determine whether risk factors for
re-bleeding through packs, or for haemorrhage-related complications, for
which inpatient admission would allow more timely treatment, could be
identified. Patient factors and outcomes were correlated using binomial
logistic regression. Results: 13 patients re-bled through nasal packing.
Statistically significant (1 tailed, P<0.05) predictors of
bleeding despite packing were male sex, hypertension diagnosis, and
aspirin use, with younger patients being at a modestly increased risk.
Warfarin or direct oral anticoagulant (DOAC) use was not associated with
increased bleeding risk. Conclusion: This study provides initial
evidence of factors that affect the risk of bleeding through packs, and
which patients may require inpatient care when packed. We recommend a
future multicentre study with larger recruitment numbers to expand upon
this pilot study’s results.