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The Packed Epistaxis Patient: Risks of Rebleeding? A Pilot Study to Inform Outpatient Management of Packed Patients
Emily Kent1, Leo Gundle2, Imogen Jones2
1University of Southampton Medical School, Southampton, UK.
The Annals of Otology, Rhinology, and Laryngology
|November 13, 2024
Summary
Re-bleeding after nasal packing for idiopathic epistaxis is uncommon (13%). Key risk factors for re-bleeding include male sex, hypertension, and aspirin use, suggesting some patients may be safely discharged home.
Area of Science:
- Otolaryngology
- Emergency Medicine
- Clinical Auditing
Background:
- Idiopathic epistaxis often necessitates inpatient admission for nasal packing and overnight observation.
- This practice may lead to unnecessary hospitalizations as many patients do not re-bleed.
Purpose of the Study:
- To investigate factors associated with re-bleeding in patients with idiopathic epistaxis requiring nasal packing.
- To develop a guideline for identifying patients suitable for discharge with nasal packing in situ.
Main Methods:
- A retrospective audit of 100 patients admitted for idiopathic epistaxis treated with non-absorbable nasal packing.
- Data collected included patient demographics, anticoagulation status, and comorbidities.
Main Results:
- 13% of patients (13/100) experienced re-bleeding.
- Significant predictors of re-bleeding were male sex (OR=9.81), aspirin use (OR=8.11), hypertension (OR=8.14), and age (OR=0.93).
Conclusions:
- Re-bleeding following nasal packing for idiopathic epistaxis is infrequent.
- Male sex, hypertension, and aspirin use are significant risk factors for re-bleeding.
- Consideration should be given to discharging patients with nasal packs in situ, with outpatient follow-up, if these risk factors are absent.
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