Data analysis
Primary outcome measure included:
Compliance to “Pack and Home” Criteria
Length of inpatient admission
Secondary outcome measures included:
- Re-bleeding post pack removal
- Re-presentation with bleeding within 48 hours
- Re-presentation within 1 month
A descriptive analysis was performed of the baseline clinical
characteristics between patients studied in loop one and loop one of the
audit. Percentages were used for the categorical variables whilst mean
and standard deviations for the continuous variables. The t-test was
used to investigate for associations between continuous variables,
whereas chi-squared test of association was used for categorical
variables. Non-parametric testing (Mann Whitney U test) had been used
for length stay. The level of statistical significance was set at p
<0.05 and confidence intervals were reported at the 95%
level. SPSS version 28 was used for statistical analysis.
The terms “Pack and Home” criteria and “outpatient management
pathway” are used synonymously in this paper. Patients that were deemed
not to be successfully managed on the outpatient pathway were those that
did met the criteria for the “Pack and Home” pathway or re-presented
with bleeding within 48 hours of discharge.
Results
414 patients presented to A&E with epistaxis in the first loop and 309
patients in the second, of which 72 (17.4%) and 59 (19.1%) patients
required nasal packing respectively. This made up the final study
population, their clinical characteristics being demonstrated in table
1. No significance in difference (p>0.05) were demonstrated
between age, sex, and nasal pack types. However patients in loop one
were more likely to be on an anticoagulants including DOACS (direct oral
anticoagulants), warfarin and antiplatelets. Patients in loop one were
more likely to have a past medical history of Atrial Fibrillation (AF)
whereas no difference was demonstrated in the prevalence of other
comorbidities between the two groups.
Table 2 shows the outcome measures for patients in loop one and loop two
of the audit study. 59 patients required nasal packing in loop two of
the audit of which 38 patients (64.4%) received inpatient care whereas
21 patients (35.6%) had outpatient care, thus outlining those that had
met the “Pack and Home” criteria. In loop two of the audit study, 56
patients (94.9%) were successfully discharged while 3 patients (5.1%)
represented within 48 hours. These 3 patients were all on the “Pack and
Home” pathway. All patients discharged with a nasal pack were reviewed
in outpatient clinic in under 3 days with nearly 1/3rdseen within 24 hours of pack removal and consideration for nasal
cautery. No difference was demonstrated for those who had represented
with epistaxis within 1 month between the two study cohorts. Image 3
demonstrates the average total length of inpatient stay in loop one to
be significantly higher at 45.7 hours whereas only 29.6 hours in loop
two (p<0.05).