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
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.
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