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Admission avoidance in acute epistaxis: a prospective national audit during the initial peak of the COVID-19 pandemic
  • John Hardman
John Hardman
The Royal Marsden Hospital
Author Profile


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: 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 acute epistaxis.

Peer review status:ACCEPTED

02 Sep 2020Submitted to Clinical Otolaryngology
07 Sep 2020Submission Checks Completed
07 Sep 2020Assigned to Editor
15 Sep 2020Reviewer(s) Assigned
03 Oct 2020Review(s) Completed, Editorial Evaluation Pending
10 Oct 2020Editorial Decision: Revise Minor
20 Oct 20201st Revision Received
21 Oct 2020Assigned to Editor
21 Oct 2020Submission Checks Completed
22 Oct 2020Reviewer(s) Assigned
23 Nov 2020Review(s) Completed, Editorial Evaluation Pending
28 Nov 2020Editorial Decision: Revise Minor
30 Nov 20202nd Revision Received
01 Dec 2020Submission Checks Completed
01 Dec 2020Assigned to Editor
01 Dec 2020Reviewer(s) Assigned
18 Dec 2020Review(s) Completed, Editorial Evaluation Pending
20 Dec 2020Editorial Decision: Accept