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Nasal Packs for Epistaxis: Predictors of Success
Author(s) -
Y. Abbas,
Muhammad Abdelkader,
Mary Theresa Adams,
A Addison,
Rajeev Advani,
Tahania Ahmed,
Vijay Alexander,
Vijay Alexander,
B. Alli,
Shaista Alvi,
Natasha Amiraraghi,
A Ashman,
Ramkishan Balakumar,
Jessica Bewick,
D. Bhasker,
Sumrit Bola,
Philippe Bowles,
Noll L. Campbell,
Nirupama Naidu,
Sean Carrie,
N. Caton,
JN Chapman,
Gaurav Chawdhary,
Matthew Cherko,
Matthew M Coates,
Kevin Conroy,
Peter Coyle,
Octavian Ionut Cozar,
Mark Cresswell,
Leslie W. Dalton,
JF Danino,
Charles Daultrey,
Kirsty Davies,
Sean Carrie,
Don D. Dick,
Panagiotis A. Dimitriadis,
Neela Doddi,
Margaret Dowling,
Rachel Easto,
Rachel Edmiston,
Matthew S. Ellis,
David Ellul,
Sally Erskine,
Andrew Evans,
Amir Farboud,
Colm Forde,
Jonathan Fussey,
A Gaunt,
Julie Gilchrist,
Risha Gohil,
Emma Gosnell,
D. Grech Marguerat,
R. Green,
RM Grounds,
Alyson Hall,
John Hardman,
Anthony D. Harris,
Lee H. Harrison,
Robert Hone,
R. Hopskins,
Emma Hoskison,
Jeffrey T. Howard,
Kristian Hutson,
D. Ioannidis,
Isma Z. Iqbal,
Nazli Janjua,
Karan Jolly,
Sen Kamal,
Todd Kanzara,
N. Keates,
Andrew Kelly,
Haroon Khan,
T. Korampalli,
M. Kuet,
Praneta Kulloo,
FNK Kwong,
Ruhi H. Lakhani,
Allison Lambert,
H. Lancer,
Colm Leonard,
Geraint Lloyd,
Emily Lowe,
Johannes Mair,
Elizabeth Maughan,
Chenkai Gao,
Ty Mayberry,
L. McCadden,
Fiona McClenaghan,
Gavin McKenzie,
Robert McLeod,
Sheneen Meghji,
Neerav R. Mehta,
Muhammad Amer Mian,
Kristijonas Milinis,
Alex Millington,
Omer Mirza,
Sona Mistry,
E. Molena,
Jensa C. Morris,
Tharsika Myuran,
Annakan Navaratnam,
E. Noon,
Ozioma C. Okonkwo,
Babatunde Oremulé,
L. Pabla,
Eva Papesch,
V. Puranik,
R. Roplekar,
Evan Ross,
Jamie Rudd,
Eliot Schechter,
Atta Owusu senior,
Neha Sethi,
S. Sharma,
Richa Sharma,
Fenella Shelton,
Z. Sherazi,
Anna Slovick,
Matthew E. Smith,
Chloe Swords,
Abd al-Rahman Tahir,
Theofano Tikka,
O. Tkachuk Hlinicanova,
Kathleen To,
Alex Tse,
E. Toll,
Kishan Ubayasiri,
Samit Unadkat,
Navdeep Upile,
Ananth Vijendren,
Hussein Walijee,
Martin Wilkie,
Richard J. Williams,
Marli Williams,
George D. Wilson,
Wing Lam Wong,
Grace LaiHung Wong,
Chen Xie,
Alex Yao,
H. Zhang
Publication year - 2020
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.13555
Subject(s) - medicine , nasal packing , prospective cohort study , referral , odds ratio , confidence interval , emergency department , surgery , cohort , nasal administration , emergency medicine , family medicine , psychiatry , immunology
Objectives To investigate factors affecting the haemostatic success of non‐dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED). Design Prospective cohort study. Setting A nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30‐day period. Participants Patients 16 years or older, presenting to the ED with acute epistaxis managed with non‐dissolvable intranasal packs. Main outcome measures The primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology. Results A cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter‐duration packs (89.9% vs. 84.3%, χ 2 P = .028). A patient survey supported longer packing duration. The most significant predictors of treatment failure were shorter packing duration (Odds Ratio (OR) = 2.3; 95% Confidence Interval (CI) = 1.4‐3.8), alongside ischaemic heart disease (OR = 1.9; 95% CI = 1.1‐3.3), normal admission haemoglobin (OR = 2.0; 95% CI = 1.2‐3.4) and no attempt at cautery following pack removal (OR = 2.5; 95% CI = 1.4‐4.2). Conclusions The majority of epistaxis patients are packed by the ED prior to referral to ENT. Once inserted, nasal packs are highly successful, with data supporting the British Rhinological Society guidance of maintaining nasal packs for around 24 hours. Further work is needed to explore alternatives to non‐dissolvable intranasal packs to improve patient experience in epistaxis.