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The Impact of Frailty on Epistaxis admission, a retrospective cohort study
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  • Timothy Davies,
  • Anton Alatsatianos,
  • Mohd Afiq Mohd Slim,
  • William Royce,
  • Andrew Whymark
Timothy Davies
University Hospital Crosshouse
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Anton Alatsatianos
Crosshouse Hospital
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Mohd Afiq Mohd Slim
University Hospital Crosshouse
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William Royce
University Hospital Crosshouse
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Andrew Whymark
University Hospital Crosshouse
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Abstract

Objectives: Epistaxis is the second most common referral to the Ear nose and throat (ENT) department. Frailty, a marker for biological vulnerability, has been shown to increase the risk of haemorrhage, but its impact in epistaxis patients is unknown. We aim to establish the impact of Clinical Frailty score, as well as other established risk factors for epistaxis, on the likelihood of admission in patients presenting to secondary care with epistaxis. Design: Retrospective cohort study Setting: University hospital Otolaryngology department Participants: Adult patients presenting to hospital with epistaxis between March 2019 and March 2020. Main outcome measures: We compare the clinical frailty score of patients admitted with epistaxis to those patients seen and treated same day. Results: 299 epistaxis presentations were identified, of which 122 (30.8%) required admission for further management. Clinical frailty score of ≥4 had an increased odds for admission (OR 3.15 (95% CI:1.94 – 5.16), p<0.001). In the majority of presentations (66.2%), patients were taking either an antiplatelet, anticoagulant or a combination of them. Of these presentations, the use of an anticoagulant (OR: 2.00 (95% CI: 1.20-1.92), p:0.10) and dual antiplatelet (OR: 2.82 (95% CI: 1.02-7.86), p:0.10, p:0.07) demonstrated increased odds of admission. Conclusions: We have shown that frailty increases the risk of admission in adult patients presenting with epistaxis. Frailty is becoming an increasingly apparent independent cause for haemorrhage in the elderly population. Careful consideration of bleeding risks, particularly in frail patients, needs addressing due to the morbidity associated with epistaxis.

Peer review status:Published

22 Oct 2020Submitted to Clinical Otolaryngology
28 Oct 2020Submission Checks Completed
28 Oct 2020Assigned to Editor
01 Nov 2020Reviewer(s) Assigned
06 Dec 2020Review(s) Completed, Editorial Evaluation Pending
20 Dec 2020Editorial Decision: Revise Major
25 Jan 20211st Revision Received
27 Jan 2021Assigned to Editor
27 Jan 2021Submission Checks Completed
28 Jan 2021Reviewer(s) Assigned
02 Feb 2021Review(s) Completed, Editorial Evaluation Pending
07 Feb 2021Editorial Decision: Revise Minor
10 Feb 20212nd Revision Received
11 Feb 2021Submission Checks Completed
11 Feb 2021Assigned to Editor
15 Feb 2021Reviewer(s) Assigned
02 Mar 2021Review(s) Completed, Editorial Evaluation Pending
07 Mar 2021Editorial Decision: Accept
23 Mar 2021Published in Clinical Otolaryngology. 10.1111/coa.13765