Discussion
We present a safe and efficient approach to managing selected patients
with epistaxis on an outpatient basis, showing only 5 % re-admission
rate. This approach can be of importance during the COVID-19 pandemic as
it can significantly help with hospital bed capacity; in a similar way,
it can facilitate health system pressure during busy periods.
We have found very few studies regarding discharging patients with
epistaxis and non-absorbable packing. Upile et al, reported 44
prospectively collected patients who safely managed at home with
Netcell® packs, reducing the number of admissions by 73%. Epistaxis
recurrence was their main unwanted event (seven cases) while
antiplatelet/anticoagulation therapy did not appear to be a barrier to
discharge3,4. Van Wyk et al, in a retrospective study
of 116 patients with epistaxis reported 46 patients discharged with
nasal packing in situ, only 16% returned due to re-bleeding, while no
other adverse effects were recorded5. Our data,
arising from a more extensive case series, demonstrate that selected
cases with non-absorbable anterior nasal packing may be safely
discharged home and a high decrease in hospital admissions can be
achieved, while re-bleeding occurred in only 5.3% of our cases. While
one could argue that these patients need to represent for packing
removal, the health system resources needed for an outpatient
appointment are not comparable to an inpatient admission.
Interestingly, based on our data, patients receiving antiplatelet
therapy or anticoagulation within the therapeutic range can also be
treated home; however, there was only a small number of such patients,
which can explain our results. On these grounds safe, generalized
conclusions cannot be made for this patient subgroup; careful clinical
assessment and decision making is important for this subgroup.
Despite the relatively large number of cases, the retrospective nature
of our study is the main limitation of our study. We used a robust
database of epistaxis admissions/ presentation in a unicentral ENT
emergency department and relevant details to minimize such bias and
present meaningful results.
In conclusion, based on our results, non-absorbable packing and planned
representation for packing removal on outpatient settings is a safe way
of managing selected patients with epistaxis; in circumstances like
COVID-19-pandemic such management can reduce hospital admissions and
relieve the pressure on the health system without compromising the
outcome.
Conflict of interest: None to declare.
Data availability statement: The data that support the findings
of this study are available on request from the corresponding author.
The data are not publicly available due to privacy or ethical
restrictions.