loading page

Risk of Re-bleeding In The Packed Epistaxis Patient: A Pilot Study To Inform Potential Outpatient Management.
  • +2
  • Leo Gundle,
  • Imogen Jones,
  • Emily Kent,
  • Harry Rosen,
  • Steven Frampton
Leo Gundle
University Hospitals Dorset NHS Foundation Trust

Corresponding Author:[email protected]

Author Profile
Imogen Jones
University Hospitals Dorset NHS Foundation Trust
Author Profile
Emily Kent
University of Southampton
Author Profile
Harry Rosen
Charing Cross Hospital
Author Profile
Steven Frampton
University Hospitals Dorset NHS Foundation Trust
Author Profile

Abstract

Background: Epistaxis management frequently includes the insertion of a non-absorbable nasal pack, and patients may often be admitted during this treatment. During the recent COVID-19 pandemic, UK guidance to discharge “suitable” patients, with pack in-situ, was published in order to minimise hospital admissions and viral nosocomial transmission. Evidence which defines patient suitability for discharge, however, is lacking. Method: The medical records of 100 patients admitted for idiopathic epistaxis in our trust, managed with non-absorbable packing, were analysed. We sought to determine whether risk factors for re-bleeding through packs, or for haemorrhage-related complications, for which inpatient admission would allow more timely treatment, could be identified. Patient factors and outcomes were correlated using binomial logistic regression. Results: 13 patients re-bled through nasal packing. Statistically significant (1 tailed, P<0.05) predictors of bleeding despite packing were male sex, hypertension diagnosis, and aspirin use, with younger patients being at a modestly increased risk. Warfarin or direct oral anticoagulant (DOAC) use was not associated with increased bleeding risk. Conclusion: This study provides initial evidence of factors that affect the risk of bleeding through packs, and which patients may require inpatient care when packed. We recommend a future multicentre study with larger recruitment numbers to expand upon this pilot study’s results.