Data analysis
Primary outcome measure included:
Compliance to “Pack and Home” Criteria
Length of inpatient admission
Secondary outcome measures included:
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).