Abstract
Objectives: Epistaxis is the second most common referral to the Ear nose
and throat (ENT) department. Frailty, a marker for biological
vulnerability, has been shown to increase the risk of haemorrhage, but
its impact in epistaxis patients is unknown. We aim to establish the
impact of Clinical Frailty score, as well as other established risk
factors for epistaxis, on the likelihood of admission in patients
presenting to secondary care with epistaxis. Design: Retrospective
cohort study Setting: University hospital Otolaryngology department
Participants: Adult patients presenting to hospital with epistaxis
between March 2019 and March 2020. Main outcome measures: We compare the
clinical frailty score of patients admitted with epistaxis to those
patients seen and treated same day. Results: 299 epistaxis presentations
were identified, of which 122 (30.8%) required admission for further
management. Clinical frailty score of ≥4 had an increased odds for
admission (OR 3.15 (95% CI:1.94 – 5.16), p<0.001). In the
majority of presentations (66.2%), patients were taking either an
antiplatelet, anticoagulant or a combination of them. Of these
presentations, the use of an anticoagulant (OR: 2.00 (95% CI:
1.20-1.92), p:0.10) and dual antiplatelet (OR: 2.82 (95% CI:
1.02-7.86), p:0.10, p:0.07) demonstrated increased odds of admission.
Conclusions: We have shown that frailty increases the risk of admission
in adult patients presenting with epistaxis. Frailty is becoming an
increasingly apparent independent cause for haemorrhage in the elderly
population. Careful consideration of bleeding risks, particularly in
frail patients, needs addressing due to the morbidity associated with
epistaxis.