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

Abstract

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). Prospective multicentre national audit over 12weeks from 6th April 2020. UK secondary care ENT departments. Adult patients with acute epistaxis. Re-presentation within 10days for patients discharged from the ED. 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 10days (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 10days. 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.