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Nasal Packs for Epistaxis: Predictors of Success
Insights
Non-dissolvable intranasal packs are highly successful for managing acute epistaxis (nosebleeds). Longer pack duration (≥21 hours) significantly improves haemostatic success, supporting current guidelines for effective nosebleed management.
Area of Science:
- Otolaryngology
- Emergency Medicine
- Clinical Research
Background:
- Acute epistaxis is a common emergency department presentation.
- Non-dissolvable intranasal packs are frequently used for haemostasis.
- Factors influencing the success of these packs require investigation.
Purpose of the Study:
- To investigate factors affecting the haemostatic success of non-dissolvable intranasal packs.
- To identify predictors of treatment failure in acute epistaxis management.
Main Methods:
- Prospective cohort study involving 969 patients across 113 UK sites.
- Data collected on epistaxis management in the emergency department (ED).
- Primary outcome: successful haemostasis after pack removal without further intervention.
Main Results:
- Nasal packs achieved an overall success rate of 87.5%.
- Longer pack duration (≥21 hours) demonstrated higher success rates (89.9%) compared to shorter durations (84.3%).
- Treatment failure predictors included shorter pack duration, ischaemic heart disease, normal admission haemoglobin, and lack of cautery attempt.
Conclusions:
- Non-dissolvable intranasal packs are highly successful for epistaxis management.
- Current guidance supporting longer pack duration (around 24 hours) is supported by this data.
- Further research into alternative packing methods is needed to enhance patient experience.
Objectives:
To investigate factors affecting the haemostatic success of non-dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED).
Design:
Prospective cohort study.
Setting:
A nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30-day period.
Participants:
Patients 16 years or older, presenting to the ED with acute epistaxis managed with non-dissolvable intranasal packs.
Main Outcome Measures:
The primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology.
Results:
A cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter-duration packs (89.9% vs. 84.3%, χ2 P = .028). A patient survey supported longer packing duration. The most significant predictors of treatment failure were shorter packing duration (Odds Ratio (OR) = 2.3; 95% Confidence Interval (CI) = 1.4-3.8), alongside ischaemic heart disease (OR = 1.9; 95% CI = 1.1-3.3), normal admission haemoglobin (OR = 2.0; 95% CI = 1.2-3.4) and no attempt at cautery following pack removal (OR = 2.5; 95% CI = 1.4-4.2).
Conclusions:
The majority of epistaxis patients are packed by the ED prior to referral to ENT. Once inserted, nasal packs are highly successful, with data supporting the British Rhinological Society guidance of maintaining nasal packs for around 24 hours. Further work is needed to explore alternatives to non-dissolvable intranasal packs to improve patient experience in epistaxis.
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