Admission avoidance in acute epistaxis: a prospective national audit
during the initial peak of the COVID-19 pandemic
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
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: 83 centres from all four UK nations submitted 2,631 valid cases.
The majority of cases were ED referrals (89.7%, n=2,358/2,631). 54.6%
were discharged from the ED following ENT review (n=1,267/2,322), of
whom 19.5% re-presented within 10 days (n=245/1,259) and 6.8% were
ultimately admitted (n=86/1,259). 46.7% of patients had a
non-dissolvable pack inserted by ED prior to referral to ENT
(n=1,099/2,355). 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