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.