One of the commonest emergencies presenting in ENT is epistaxis. The presentation can be through accident and emergency or through ward referrals. In this national audit of epistaxis management involving 113 centres, it was noted that 33 of the 985 patients (3.35%) died within 30 days of referral to ENT. Mortality involved a quarter of the patients referred from a ward. The incidence of comorbidities, ranging from bleeding diathesis, cardiovascular conditions, diabetes and infective conditions, was higher in the deceased group as compared with the live group. A paradoxical finding has been an earlier control of epistaxis in the deceased group.
The study showed that the mean Modified Early Warning System value and median WHO scores were not significantly different between the deceased and the live groups, suggesting that the latter is not a good predictor of the risk of death in epistaxis patients.
In this series, no patient died as a direct result of epistaxis. Interestingly, this study has shown a higher risk of mortality from epistaxis generally and specifically in patients previously admitted to other wards with comorbidities. The authors support early reversal of antithrombotic agents and aggressive transfusion policies blood transfusion.