Hospital-avoidance with Outpatient Management of Epistaxis (HOME): which epistaxis patients packed with a Rapid RhinoTM are potentially appropriate for outpatient management?

Background: Epistaxis is an ear nose and throat (ENT) emergency accounting for a significant number of emergency department presentations. Traditionally patients requiring non-dissolving nasal balloon packing (Rapid RhinoTM) have required hospital admission with the packing left in situ for 24–48 hours. This research explores which patients are likely to require inpatient management, with an attempt to define a subgroup who are safe to be managed in the outpatient setting. 

Methods: Observational study with retrospective review of epistaxis ENT admissions between 1 ^st January 2019 and 31 ^st December 2020 at Flinders Medical Centre, South Australia. Data extracted include patient demographics, co-morbidities, recent nasal surgery, anti-platelet/anti-coagulant use and if surgical management or interventional radiology/embolisation was required. The primary outcome was whether the patient required unplanned review by a medical officer, used as a proxy to identify those patients less suitable for outpatient management. 

Results: A total of 207 admissions coded with epistaxis were identified, 171 patients required the insertion of at least one nasal balloon pack to control bleeding. Significant risk factors for requiring unplanned medical review were abnormal systolic blood pressure (SBP) (>170 or <90 mmHg) (P=0.002) and dementia/ cognitive impairment (P=0.04). Recent nasal surgery (P=0.03) and ≥1 recent presentation with epistaxis (P=0.009) were risk factors for requiring a surgical procedure to control epistaxis. One hundred and eighteen epistaxis patients requiring packing were found to require unplanned medical review, surgical management or interventional radiology/embolisation. The remaining 53 patients (31%) were identified as not having factors requiring active inpatient management. 

Conclusions: This retrospective study has identified that approximately 31% of patients could potentially be discharged home with a nasal balloon pack in situ with follow-up in outpatient clinic within 48 hours for packing removal. This hospital avoidance will reduce pressure on public hospital system.