Admission avoidance in acute epistaxis: A prospective national audit during the initial peak of the COVID‐19 pandemic. (4th February 2021)

• Record Type: Journal Article
• Authors: Hardman, John C.
• Other Names: Smith Matthew E. investigator.; Swords Chloe investigator.; Rocke John P. J. investigator.; Walker Abigail investigator.; Bryan James E. investigator.; Milinis Kristijonas investigator.; Mathew Rajeev G. investigator.; Jones Gareth H. investigator.; McLaren Oliver investigator.; Hutson Kristian investigator.; Slovick Anna investigator.; Hopkins Claire investigator.; Harries Philip G. investigator.; Heward Elliot investigator.; Shakeel Muhammad investigator.; Gomati Anas investigator.; Bance Manohar investigator.; Lancaster Jeffrey investigator.; Gaskell Peter investigator.; Smyth Catherine investigator.; Dorris Colm investigator.; Kelly Andrew investigator.; McCrory David investigator.; Bhatt Yogesh M. investigator.; Jama Guled M. investigator.; Morgan Montio investigator.; Perkins Victoria investigator.; Spraggs Paul investigator.; Khosla Shivun investigator.; Takwoingi Yohanna investigator.; Gopala‐Krishnan Srinish investigator.; Strachan David investigator.; Omakobia Eugene investigator.; Puvanendran Mark investigator.; Myuran Tharsika investigator.; Rennie Catherine investigator.; Devabalan Yadsan investigator.; Cardozo Arun investigator.; Tse Antonia investigator.; McRae Duncan investigator.; Burgan Omar T. investigator.; Reddy Ekambar investigator.; Wright Brendan investigator.; Kara Naveed investigator.; Ivy Ashleigh investigator.; Williams Richard investigator.; Walkden Alex investigator.; Quraishi Muhammad investigator.; Stobbs Nicola investigator.; Chatzimichalis Michail investigator.; Elston Emily investigator.; Khemani Sameer investigator.; Liu Alison investigator.; Kirkland Paul investigator.; Vasanthan Rishi investigator.; Miah Mohammed investigator.; Lee Kristina investigator.; Mclarnon Claire investigator.; Williams Mark R investigator.; Okonkwo Okechukwu investigator.; Mughal Zahir investigator.; Karagama Yakubu investigator.; Xie Carol investigator.; De Mriganka investigator.; Amlani Aakash investigator.; Jassar Patrick investigator.; Cao Han investigator.; Patil Sachin investigator.; Philpott Carl investigator.; Meghji Sheneen investigator.; Das Sudip investigator.; Cole Simon investigator.; Vijendren Ananth investigator.; Ally Munira investigator.; Kothari Prasad investigator.; Schechter Eyal investigator.; Ranganathan Baskaran investigator.; Advani Rajeev investigator.; Toma Shamim investigator.; Haymes Adam investigator.; Shakir Adam investigator.; Yap Darren investigator.; Costello Rhodri investigator.; Evans Louise investigator.; Chisholm Edward investigator.; Ojha Shilpa investigator.; Spielmann Patrick investigator.; Steven Richard investigator.; Supriya Mrinal investigator.; Mathew Elizabeth investigator.; Masood Ajmal investigator.; Dewhurst Samuel investigator.; Ward Victoria investigator.; Haigh Thomas investigator.; Patiar Shalini investigator.; Nemeth Zsofia investigator.; Terry Roland investigator.; Vithlani Rohan investigator.; Bowyer Duncan investigator.; Yang Ding investigator.; Monksfield Peter investigator.; Muzaffar Jameel investigator.; Siddiq Azher investigator.; Whittaker Joshua D investigator.; Ramakrishnan Yujay investigator.; Vakharia Nilesh investigator.; Cain Angus investigator.; Cooper Fergus investigator.; Izzat Steve investigator.; Nair Dilip investigator.; Tan Shawn investigator.; Daudia Anu investigator.; Gilchrist Jennifer investigator.; Tan Neil investigator.; Kim Min investigator.; Singh Vijay investigator.; Hallett Emma investigator.; Ray Jaydip investigator.; Yu Beverley investigator.; DeCarpentier John investigator.; Chandrasekar Bhargavi investigator.; Bhimrao Sanjiv investigator.; Eastwood Michael investigator.; Sunkaraneni Vishnu S. investigator.; Patel Jamie investigator.; Moore Andrew investigator.; Shetty Prajwal investigator.; Mawby Thomas investigator.; Shelton Fenella investigator.; Jindal Mudit investigator.; Yao Alexander investigator.; Geyer Marcel investigator.; Lowe Emily investigator.; Jones Huw investigator.; Ghasemi Aria Amir investigator.; Trinidade Aaron investigator.; Hardy Alistair investigator.; Little Sarah investigator.; Munroe‐Gray Tiffany investigator.; Bennett Alex investigator.; Li Lucy investigator.; Khalid‐Raja Mamoona investigator.; McNally George investigator.; Thomas George investigator.; Elmorsy Mohamed investigator.; Williams Clare investigator.; Zammit Matthew investigator.; Seymour Kay investigator.; Warner Elinor investigator.; Potter Chris investigator.; Easto Rachel investigator.; Shaida Azhar investigator.; Forde Cillian T. investigator.; Karamchandani Dheeraj investigator.; Gill Charn investigator.; Syed Irfan investigator.; Walker David investigator.; Stewart Kirsten investigator.; Simmons Mark investigator.; Abou‐Foul Ahmad K investigator.; Bathala Srinivasalu investigator.; Emerson Hannah investigator.; Almeyda John investigator.; Leadon Madeline investigator.; Fahmy Fahmy investigator.; Kaleva Anna I. investigator.; Moorthy Ram investigator.; Bates James investigator.; Wasson Joseph investigator.; Selwyn Anya investigator.; Daultrey Charles investigator.; Patel Sanjay investigator.; Siau Derrick investigator.; Sawant Rupali investigator.; Moore Phillip investigator.; Ali Faiza investigator.;
• Is Part Of: Clinical otolaryngology. Volume 46:Number 3(2021)
• Page Start: 577
• Page End: 586
• Publication Date: 2021-02-04
• Subjects: ambulatory -- discharge -- multicentre -- observational -- outpatient; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1111/coa.13716
• Languages: English
• ISSNs: 1749-4478

Abstract

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: 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 10 days (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 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.