Results
We found a total of 885 adult epistaxis cases in our database (Table 1). We discharged home 772 patients while 113 were admitted. Two hundred and twenty (220) patients were treated with only ice and pressure and discharged; 84 patients treated with cautery (80 chemical/4 bipolar) and discharged. Absorbable anterior packing was used in 15 cases; 14 discharged and 1 was admitted. Non-absorbable anterior packing was used in 519 patients (58.6% of all cases); 454 of them (87.5%) were discharged home with packing (home patient group). Merocel® (Medtronic XOMED, Jacksonville, FL, USA) was used in 294 and gauge in 160 patients. In all cases packing was soaked in mupirocin nasal ointment in order to avoid toxic shock syndrome and in all cases was removed within 48 hours in ENT emergency department. All “home patients” fulfilled the inclusion criteria as above. Posterior packing was used in 47 patients and all of them were admitted.
From the “home patients” with non-absorbable packing 12 were receiving antiplatelet and 10 anticoagulant therapy. Antiplatelet therapy was not withdrawn while in all patients under anticoagulant therapy INR was within therapeutic range.
Bleeding recurrence occurred in 24 patients (5.3%) of the home group. These patients were treated as inpatients; 3 with cautery, 7 with non-absorbable anterior packing, 9 with posterior packing, and 5 with surgical intervention as necessary. Interesting, no recurrence occurred in the antiplatelet/anticoagulant subgroup.
No packing related complications were noticed in “home patients”.
During the ‘second wave’ of COVID-19-pandemic we have followed this policy in 24 patients who consented to be discharged home. It should be noticed that, above others all of them were afraid the risk of COVID-19 contagion by staying in the hospital; none of the 24 patients had to be admitted.