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Deekonda P, Mirza AH, Jones H. Impact of the COVID-19 pandemic on acute otolaryngology inpatient activity at a tertiary referral centre: a retrospective analysis. Clin Otolaryngol 2022; 47:447-454. [PMID: 35191188 PMCID: PMC9111863 DOI: 10.1111/coa.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/02/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
Objective To determine the impact of the COVID‐19 pandemic on acute admissions and inpatient activity at a tertiary referral centre. Design Retrospective review of coding‐based inpatient electronic records. Setting An otolaryngology and head and neck surgery department at a major UK trauma and tertiary referral centre. Participants Otolaryngology patients admitted as an emergency over a period of 10 months pre‐COVID19 (01/04/2019‐23/01/2020) and 10 months post‐COVID19 (01/04/2020‐23/01/2021). Main outcome measures Baseline characteristics, admission rates, length of stay (LoS), overall mortality and 30‐day mortality. Results A total of 1620 records were reviewed; (1066 pre‐COVID19, 554 post‐COVID19). Admissions across all age groups were reduced, with an increase in mean age from 39.88 to 47.4 years (p = .018). LoS remained unchanged (3.85 vs 3.82 days, p = .160). Infection remained the most common presentation, followed secondly by epistaxis which entailed an increased LoS compared to the pre‐COVID19 cohort. GP referrals reduced from 18.3% to 4.2% (n = 195 vs n = 23, p < .001) and ED referrals proportionally increased from 71.9% to 85.9% (n = 766 vs n = 476, p < .001). Critical care admissions were higher in the post‐COVID19 cohort (OR 1.78 (1.07–2.98) [95% CI], p = .027). There was no significant difference in overall mortality between groups (n = 60, 5.6% vs. n = 33, 6.0%; p = .844). Thirty‐day mortality increased from 0.9% (n = 12) pre‐COVID19 to 2.3% (n = 13) post‐COVID19 (p = .039). Conclusions This study demonstrates significant changes and a reduction in acute otolaryngology presentations. Our findings may suggest that sicker, frailer patients were admitted during the pandemic. This study reports the observational effect that the pandemic has had on acute otolaryngology admissions, which may be relevant in addressing unmet care needs in the post‐pandemic period.
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Affiliation(s)
- Praveena Deekonda
- Department of Otolaryngology, Southampton General Hospital, University Hospital Southampton NHS Trust, Tremona Road, SO16 6YD, Southampton, United Kingdom
| | - Adal Hussain Mirza
- Department of Otolaryngology, Southampton General Hospital, University Hospital Southampton NHS Trust, Tremona Road, SO16 6YD, Southampton, United Kingdom
| | - Huw Jones
- Department of Otolaryngology, Southampton General Hospital, University Hospital Southampton NHS Trust, Tremona Road, SO16 6YD, Southampton, United Kingdom
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Anti-thrombotics and their impact on inpatient epistaxis management: a tertiary centre experience. Ir J Med Sci 2021; 191:1621-1629. [PMID: 34562192 PMCID: PMC9308617 DOI: 10.1007/s11845-021-02790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/18/2021] [Indexed: 11/03/2022]
Abstract
Introduction Epistaxis represents a massive burden upon NHS resources. Despite being an extremely common reason for emergency ENT admissions, there remains significant variation in its management. Although the evidence base is continually growing, there appears to be a lack of guidance towards managing anti-coagulants and anti-platelet medications and identifying patient-specific outcomes in this setting. Epistaxis has long been associated with a multitude of risk factors but none have shown consistent, direct correlation. Materials and methods We aimed to identify if the use of anti-thrombotic medication was associated with a longer length of hospital admission or conferred a higher requirement for nasal packing, re-packing, surgery or re-admission. We conducted a retrospective analysis of 100 consecutive adult patients admitted over a 6-month period. Statistical analysis was conducted using SPSS software. Results Sixty-five percent of patients were taking anti-thrombotic medication. The variability of admission INR values in those taking warfarin did not relate with any outcome measure. There was no statistical difference between patients taking anti-thrombotic medication and those who do not, with regards to our primary outcome measures. Re-admission rates within 28 days were found to be 13%, with anti-thrombotic medication use and pre-existing cardiovascular disease recognised as commonly encountered risk factors. Three percent of patients required surgical intervention. Eight percent of patients required re-packing, with a Rapid Rhino chosen in all instances. Conclusion The use of anti-thrombotic medication is not associated with increased morbidity or increased rate of complications. Anti-thrombotic usage and more than one medical co-morbidity increase the risk of re-admission within 28 days.
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Althaus AE, Lüske J, Arendt U, Dörks M, Freitag MH, Hoffmann F, Jobski K. Treating epistaxis - who cares for a bleeding nose? A secondary data analysis of primary and secondary care. BMC FAMILY PRACTICE 2021; 22:75. [PMID: 33858351 PMCID: PMC8051091 DOI: 10.1186/s12875-021-01411-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022]
Abstract
Background The primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years. The secondary objective was to evaluate the value of the practice fee as an instrument of allocation in patients with epistaxis. Methods Anonymized statutory health insurance data (AOK Lower Saxony) of patients with a diagnosis of epistaxis treated between 2007 and 2016 were examined. Demographic data, accompanying diagnoses, medication and involved medical groups (general practitioners (GP), pediatricians, ear, nose and throat (ENT) specialists or other) were analyzed. Furthermore, we assessed whether the use of specialist groups changed after abolition of the practice fee in 2013. Results Epistaxis was responsible for 302,782 cases (160,963 patients). The distribution of cases was slightly in favor of ENT specialists vs. GP (119,170 vs. 110,352). The cases seen by GP and ENT specialists were comparable with regard to age and sex distribution. Hypertension, atrial fibrillation/flutter and an antithrombotic therapy were slightly more common among cases consulting a GP. The GP recorded more co-diagnoses than the ENT. The use of outpatient care and the proportions of the involved physicians scarcely fluctuated during the study period. Overall, 23,118 patients (14.4%) were diagnosed by both, GP and ENT during a relatively short time period. The practice fee remuneration had no impact on the consultation of the physician groups. Conclusion The outpatient treatment of epistaxis constitutes a considerable medical and economic burden in Germany. Strengthening the primary medical sector (GP-centered care) is necessary to reach the goal of initially directing patients to primary care, providing specialists more time for severe cases and reducing the impact on public health balance sheets.
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Affiliation(s)
- Annina E Althaus
- Division of General Practice and Family Medicine, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany. .,Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany.
| | - Jonas Lüske
- Department of Audiology and Phoniatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Arendt
- Division of General Practice and Family Medicine, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Michael Dörks
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Michael H Freitag
- Division of General Practice and Family Medicine, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Kathrin Jobski
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Davies T, Alatsatianos A, Slim MAM, Royce W, Whymark A. The impact of frailty on epistaxis admission, a retrospective cohort study. Clin Otolaryngol 2021; 46:983-990. [PMID: 33756072 DOI: 10.1111/coa.13765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/10/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Epistaxis is frequently managed with intra-nasal packing devices, traditionally requiring patient admission. Current COVID-19 guidelines encourage ambulatory care where possible in this patient cohort. This paper aims to establish the impact of the Clinical Frailty Scale, anticoagulant/antiplatelet therapeutics and season variation on pre-pandemic admissions to help identify patients suitable for ambulatory epistaxis management. DESIGN Retrospective cohort study SETTING: Scottish Regional Health Board PARTICIPANTS: Adult patients attending secondary care with epistaxis between March 2019 and March 2020. MAIN OUTCOME MEASURES Likelihood of epistaxis hospital admission based on Clinical Frailty Scale. RESULTS 299 epistaxis presentations were identified, of which 122 (40.8%) required admission. Clinical Frailty Scale of ≥4 had an increased likelihood of admission (OR 3.15 (95% CI:1.94-5.16), P < .05). In the majority of presentations (66.2%), patients were taking either an antiplatelet or anticoagulant. Of these presentations, the use of an anticoagulant (OR: 2.00 (95% CI: 1.20-3.33), P < .05 and dual antiplatelet (OR: 2.82 (95% CI: 1.02-7.86), P < .05) demonstrated increased likelihood of admission. CONCLUSIONS We have shown that frailty increases the risk of admission in adult patients presenting with epistaxis. Clinical Frailty Scale (CFS) could be utilised in risk stratification to identify suitable patients for outpatient management. Patients with CFS ≤ 3 could be considered for outpatient management of their epistaxis. It is likely that patients with CFS ≥4 on anticoagulant or dual antiplatelet will require admission.
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Affiliation(s)
- Timothy Davies
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
| | - Anton Alatsatianos
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
| | - Mohd Afiq Mohd Slim
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
| | - William Royce
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
| | - Andrew Whymark
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
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Jeong H, Choi B, Lee J, Kim KS, Min SJ, Kim JK. Prevalence and characteristics of S-point bleeding compared to non S-point bleeding in severe epistaxis. Braz J Otorhinolaryngol 2020; 87:462-468. [PMID: 33012702 PMCID: PMC9422729 DOI: 10.1016/j.bjorl.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/17/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Stamm's S-point is gaining importance as a bleeding focus in severe epistaxis. However, prevalence and features of S-point bleeding compared to non S-point bleeding have not been studied. Objective To investigate the characteristics of patients with S-point bleeding among those with severe epistaxis and to compare the factors involved in the treatment of epistaxis. Methods We retrospectively analyzed medical records of 268 patients admitted to the otorhinolaryngology department of Konkuk University Hospital and Chung-Ang University Hospital with epistaxis of which the bleeding focus clarified. Patients with anterior nasal bleeding (n = 129) were excluded. The study was conducted at the department of otorhinolaryngology from January 2008 to August 2019. Collected data included patients’ demographic information, bleeding focus, body mass index underlying medical and sinonasal diseases, laboratory test results (initial hemoglobin, platelet count, and triglyceride level), use of anticoagulants, direction of epistaxis, initial and final treatments, and need for blood transfusion. Results The prevalence of S-point bleeding was 28.8% of non-anterior bleeding cases. Mean body mass index score was lower in the S-point group (23.41 ± 3.71) compared to the non S-point group (24.93 ± 3.97) (p = 0.039). Underweight patients tended to show a greater incidence of S-point bleeding (15.0%) than non S-point bleeding (2.0%) (p = 0.010). Incidence of anemia was higher in the S-point group (67.5%) than in the non S-point group (36.4%). Anemia (Odds ratio [OR]: 3.635; 95% confidence interval [CI]: 1.669-7.914, p = 0.001) and underweight (body mass index < 18.5, OR: 8.559, CI: 1.648-44.445, p = 0.011) were significantly associated with S-point bleeding. Conclusion Prevalence of S-point bleeding was significant, underlining the importance of examining the S-point in patients with severe epistaxis. Patients with S-point bleeding had lower body mass index scores and a higher incidence of anemia than those with non S-point bleeding.
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Affiliation(s)
- Hamin Jeong
- Konkuk University Medical Center, Konkuk University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - BoYoon Choi
- Konkuk University Medical Center, Konkuk University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Jiyeon Lee
- Konkuk University Medical Center, Konkuk University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Kyung Soo Kim
- Chung-Ang University, College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Sung Jin Min
- Chung-Ang University, College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea
| | - Jin Kook Kim
- Konkuk University Medical Center, Konkuk University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul, Republic of Korea.
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Kallenbach M, Dittberner A, Boeger D, Buentzel J, Kaftan H, Hoffmann K, Jecker P, Mueller A, Radtke G, Guntinas-Lichius O. Hospitalization for epistaxis: a population-based healthcare research study in Thuringia, Germany. Eur Arch Otorhinolaryngol 2020; 277:1659-1666. [PMID: 32124006 PMCID: PMC7198635 DOI: 10.1007/s00405-020-05875-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022]
Abstract
Purpose Epistaxis is the most common ENT emergency. The aim was to determine population-based data on severe epistaxis needing inpatient treatment. Methods Retrospective population-based cohort study in the federal state Thuringia in 2016 performed on all 840 inpatients treated for epistaxis in otolaryngology departments (60.1% male, median age: 73 years; 63.9% under anticoagulation). The association between patients’ and treatment characteristics and longer inpatient stay (≥ 4 days) as well as readmission for recurrent epistaxis was analyzed using univariable and multivariable statistics. Results The overall incidence of epistaxis needing inpatient treatment was higher for men (42 per 100,000) than for women (28 per 100,000). The highest incidence was reached for men > 85 years (222 per 100,000). Most important independent predictors for longer inpatient stay were localization of the bleeding not in the anterior nose (OR = 2.045; CI = 1.534–2.726), recurrent bleeding during inpatient treatment (OR = 2.142; CI = 1.508–3.042), no electrocoagulation (OR = 2.810; CI = 2.047–3.858), and blood transfusion (OR = 2.731; CI = 1.324–5.635). Independent predictors for later readmission because of recurrent epistaxis were male gender (OR = 1.756; CI = 1.155–2.668), oral anticoagulant use (OR = 1.731; CI = 1.046–2.865), and hereditary hemorrhagic telangiectasia (OR = 13.216; CI 5.102–34.231). Conclusions Inpatient treatment of epistaxis seems to be variable in daily routine needing standardization by clinical guidelines and strategies to shorten inpatient treatment and to reduce the risk of readmission. Electronic supplementary material The online version of this article (10.1007/s00405-020-05875-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Max Kallenbach
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - Andreas Dittberner
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, Zentralklinikum, Suhl, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum, Erfurt, Germany
| | - Kerstin Hoffmann
- Department of Otorhinolaryngology, Sophien/Hufeland-Klinikum, Weimar, Germany
| | - Peter Jecker
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Andreas Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany
| | - Gerald Radtke
- Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany.
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Lin Y, Yasheng M, Zhang H, Rouzi M, Zunong M, Wu X. Characteristics and treatment of patients with epistaxis over the last 5 years in Guangzhou. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919892150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Epistaxis is one of the most common emergencies in the department of otolaryngology, which gives a burden to the health care system. Objectives: This study aimed to investigate the patients’ characteristics of hospital admission with epistaxis and provide an optimized protocol. Methods: This study was a retrospective analysis of patients with epistaxis admitted to The Third Affiliated Hospital of Sun Yat-sen University in Guangzhou, China. The data were analyzed in terms of gender, age, seasonal differences, length and expenses of hospitalization, pathogenesis of epistaxis, primary medical management before hospital admission, bleeding sites, and treatment. Results: A total of 387 patients were included, which consisted of 270 males and 117 females with an average of 43 years. Most patients could be identified with underlying diseases, and the most commonly observed bleeding site was Little area (n = 164). Most patients received electrocauterization as a precision medical treatment (n = 288). The duration of hospitalization length ranged from a mean of 5.17–4.48 days, and the expenses of hospitalization ranged from a mean of RMB 4881–4951 yuan over the last 5 years. Conclusion: Most patients with epistaxis could be treated as outpatients by endoscopic electrocauterization, and hospitalization is indicated when patients need improvement of poor general condition, posterior packing, embolization, or surgery. This study enables to provide an optimized protocol for patient with epistaxis.
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Affiliation(s)
- Yong Lin
- Department of Otolaryngology Head and Neck Surgery, The First People’s Hospital of Kashi District, Kashi, China
| | - Maimaitiyiming Yasheng
- Department of Otolaryngology Head and Neck Surgery, The First People’s Hospital of Kashi District, Kashi, China
| | - Heyue Zhang
- Department of Otolaryngology Head and Neck Surgery, The First People’s Hospital of Kashi District, Kashi, China
| | - Mireguli Rouzi
- Department of Otolaryngology Head and Neck Surgery, The First People’s Hospital of Kashi District, Kashi, China
| | - Mierban Zunong
- Department of Otolaryngology Head and Neck Surgery, The First People’s Hospital of Kashi District, Kashi, China
| | - Xifu Wu
- Department of Otolaryngology Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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One-year all-cause mortality for 338 patients admitted with epistaxis in a large tertiary ENT centre. The Journal of Laryngology & Otology 2019; 133:487-493. [PMID: 31062677 DOI: 10.1017/s0022215119000860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Epistaxis is the most common ENT emergency. This study aimed to assess one-year mortality rates in patients admitted to a large teaching hospital. METHOD This study was a retrospective case note analysis of all patients admitted to the Queen Elizabeth University Hospital in Glasgow with epistaxis over a 12-month period. RESULTS The one-year overall mortality for a patient admitted with epistaxis was 9.8 per cent. The patients who died were older (mean age 77.2 vs 68.8 years; p = 0.002), had a higher Cumulative Illness Rating Scale-Geriatric score (9.9 vs 6.7; p < 0.001) and had a higher performance status score (2 or higher vs less than 2; p < 0.001). Other risk factors were a low admission haemoglobin level (less than 128 g/dl vs 128 g/dl or higher; p = 0.025), abnormal coagulation (p = 0.004), low albumin (less than 36 g/l vs more than 36 g/l; p < 0.001) and longer length of stay (p = 0.046). CONCLUSION There are a number of risk factors associated with increased mortality after admission with epistaxis. This information could help with risk stratification of patients at admission and enable the appropriate patient support to be arranged.
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