Results
We found a total of 885 adult epistaxis cases in our database (Table 1).
We discharged home 772 patients while 113 were admitted. Two hundred and
twenty (220) patients were treated with only ice and pressure and
discharged; 84 patients treated with cautery (80 chemical/4 bipolar) and
discharged. Absorbable anterior packing was used in 15 cases; 14
discharged and 1 was admitted. Non-absorbable anterior packing was used
in 519 patients (58.6% of all cases); 454 of them (87.5%) were
discharged home with packing (home patient group). Merocel® (Medtronic
XOMED, Jacksonville, FL, USA) was used in 294 and gauge in 160 patients.
In all cases packing was soaked in mupirocin nasal ointment in order to
avoid toxic shock syndrome and in all cases was removed within 48 hours
in ENT emergency department. All “home patients” fulfilled the
inclusion criteria as above. Posterior packing was used in 47 patients
and all of them were admitted.
From the “home patients” with non-absorbable packing 12 were receiving
antiplatelet and 10 anticoagulant therapy. Antiplatelet therapy was not
withdrawn while in all patients under anticoagulant therapy INR was
within therapeutic range.
Bleeding recurrence occurred in 24 patients (5.3%) of the home group.
These patients were treated as inpatients; 3 with cautery, 7 with
non-absorbable anterior packing, 9 with posterior packing, and 5 with
surgical intervention as necessary. Interesting, no recurrence occurred
in the antiplatelet/anticoagulant subgroup.
No packing related complications were noticed in “home patients”.
During the ‘second wave’ of COVID-19-pandemic we have followed this
policy in 24 patients who consented to be discharged home. It should be
noticed that, above others all of them were afraid the risk of COVID-19
contagion by staying in the hospital; none of the 24 patients had to be
admitted.