P15\u2002Admission avoidance in acute epistaxis: a prospective national audit during the initial peak of the COVID-19 pandemic

Abstract

Abstract Introduction In March 2020, UK epistaxis guidelines were issued incorporating major shifts in standard practice, namely the recommended use of dissolvable products and discharge of patients with non-dissolvable packs. The aim of this audit was to assess patient outcomes following epistaxis care during the initial COVID-19 peak, exploring factors relating to unscheduled re-presentations. Methods A UK-wide prospective multicentre national audit was performed over 12-weeks from 6th April 2020 at ENT departments treating adults with epistaxis. The primary outcome was re-presentation within 10-days. Univariable binary logistic regression analysis was used to identify significant determinants of the primary outcome measure. Results 83 centres from all four UK nations submitted 2,631 cases, the majority of which were Emergency Department (ED) referrals (89.7%). ENT clinicians used a dissolvable intranasal product in 34.7% of patients overall (n\u2009=\u2009816/2,351), and in 61.1% of those receiving an intranasal product (n\u2009=\u2009816/1,336). 54.6% were discharged from the ED following ENT review. The overall re-presentation rate was 19.5% for ED discharges (n\u2009=\u2009245/1,259) and 9.9% for ED admissions (n\u2009=\u2009104/1,046). 6.8% of ED discharges and 5.7% of ED admissions were admitted following their re-presentations (n\u2009=\u200986 and 60 respectively). Not being packed by ED clinicians, antiplatelet medications, failed cautery and recent epistaxis treatment were predictors of re-presentation within 10-days. Discussion Re-presentation data were similar to the 2016 UK Epistaxis Audit, however, there was a notable shift towards alternative packing techniques and reduced admission. This highlights that many patients who would previously have necessitated admission may be safely discharged from ED.