Methods
The protocol for this study was published in advance athttps://entintegrate.co.uk.
This manuscript has been prepared with reference to the STROBE checklist
for cohort studies.10
Ethical considerations
The Health Research Authority decision tool determined the study design
to fall under the remit of audit, and so no ethical approval was
required (available at:http://www.hra-decisiontools.org.uk/research/).
Study design and setting
A national prospective audit of the hospital management of acute
epistaxis by UK secondary care ENT departments was conducted, in
parallel to an audit of tonsillitis and peritonsillar abscess emergency
care.11 The audit was developed and run by INTEGRATE,
the UK ENT Trainee Research Network. All UK ENT departments were invited
to participate via advertisement, and registration with local audit and
Clinical Governance Departments was required. Sites could open at any
point during the prospective data collection period.
Participants
Consecutive patients with acute epistaxis, aged 18 years and older, and
referred to ENT secondary care were eligible for inclusion, whether
managed by telephone advice or face-to-face review. Traumatic epistaxis
was excluded.
Data collection
Eligible cases were identified over a 12 week period, between 6th April
and 29th June 2020. Each case was followed-up for 10 days. A
standardised electronic case report form was created using Excel
software (Microsoft Corporation, Washington, USA) and made available
online (Supplementary material), incorporating data validation to
encourage valid data entry and completeness. Data were initially held
offline at each centre, and patient identifiable data were removed prior
to submission to the project management team. Data were collected on:
patient demographics; COVID-19 status; referring and reviewing
clinicians; relevant comorbidities, medications history and
administration; and intranasal management strategies.
Interim reports
The 12 week audit was divided into three 4-week periods. Two interim
reports were produced (after periods 1 and 2) allowing for rapid
feedback of management and preliminary outcomes to the UK ENT community.
Both interim reports were disseminated electronically via ENTUK mailouts
within 10 days of data submission and hosted online athttps://entuk.org andhttps://entintegrate.co.uk.
Data analysis
The primary outcome was unscheduled re-presentation to hospital within
10 days for ED discharges. This intended to assess the safety of the
lower rates of admission anticipated.
Univariable binary logistic regression analysis was used to identify
significant determinants of the primary outcome measure. The level of
significance was set at <0.05 with Bonferroni corrections
applied, where applicable. Analysis was performed using R statistical
software (R Foundation, Vienna, Austria).