Description:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To report changes in practice brought about by COVID‐19 and the implementation of new guidelines, and to explore factors relating to unscheduled re‐presentations for patients discharged from the emergency department (ED).</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective multicentre national audit over 12 weeks from 6th April 2020.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>UK secondary care ENT departments.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Adult patients with acute epistaxis.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Re‐presentation within 10 days for patients discharged from the ED.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Eighty three centres from all four UK nations submitted 2631 valid cases. The majority of cases were ED referrals (89.7%, n = 2358/2631). 54.6% were discharged from the ED following ENT review (n = 1267/2322), of whom 19.5% re‐presented within 10 days (n = 245/1259) and 6.8% were ultimately admitted (n = 86/1259). 46.7% of patients had a non‐dissolvable pack inserted by ED prior to referral to ENT (n = 1099/2355). The discharge rates for ED patients and their subsequent re‐presentation rates were as follows: non‐dissolvable packs, 29.5% discharged (n = 332/1125), 18.2% re‐presented (n = 60/330); dissolvable products, 71.1% discharged (n = 488/686), 21.8% re‐presented (n = 106/486); cautery only, 89.2% discharged (n = 247/277), 20.0% re‐presented (n = 49/245); and no intranasal intervention, 85.5% discharged (n = 200/234), 15.2% re‐presented (n = 30/198). Univariable logistic regression showed that not being packed by ED, antiplatelet medications, failed cautery and recent epistaxis treatment were significant predictors of re‐presentation within 10 days.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Management of acute epistaxis was notably affected during the initial peak of the pandemic, with a shift towards reduced admissions. This national audit highlights that many patients who may previously have been admitted to hospital may be safely discharged from the ED following acute epistaxis.</jats:p></jats:sec>