Is the nasal tampon a suitable treatment for epistaxis in Accident & Emergency? A comparison of outcomes for ENT and A&E packed patients
Andrew S. Evans M.B., Ch.B., M.R.C.S., D.L.O. a1, David Young Ph.D, M.Phil, B.Sc. a2andRichard Adamson M.B., Ch.B, F.R.C.S. a1 a1 Department of Otolaryngology and Head and Neck Surgery, Western General Hospital,Edinburgh. a2 Research and Development Office, Royal Hospital for Sick Children, Yorkhill,Glasgow and Department of Statistics and Modelling Science,University of Strathclyde, Glasgow.
This retrospective observational study aimed to establish the outcome for patients packed with a nasal tampon as first-line therapy for epistaxis in Accident & Emergency compared to those packed by ENT. During our study period, 189 admissions were treated with a nasal tampon as first-line therapy; 89 were inserted by ENT and 100 by A&E. A significantly higher number of patients packed by A&E required further treatment to control bleeding (p = 0.004; 95 per cent CI 7–34) than those in the group packed by ENT. A significantly greater proportion from the A&E group required additional cautery alone to control bleeding (p = 0.005; 95 per cent CI 5–30). We suggest that this may be due to inadequate initial assessment and inappropriate first-line therapy in the A&E department. It is recommended that ENT review patients prior to packing, in order to reduce the morbidity associated with multiple treatments.