Objectives: To report changes in practice brought about by COVID-19 and the implementation of new guidelines, and to explore factors relating to unscheduled re-presentations for patients discharged from the emergency department (ED).

Design: Prospective multicentre national audit over 12 weeks from 6th April 2020.

Setting: UK secondary care ENT departments.

Participants: Adult patients with acute epistaxis Main outcome measures Re-presentation within 10 days for patients discharged from the ED.

Results: 83 centres from all four UK nations submitted 2,631 valid cases. The majority of cases were ED referrals (89.7%, n=2,358/2,631). 54.6% were discharged from the ED following ENT review (n=1,267/2,322), of whom 19.5% re-presented within 10 days (n=245/1,259) and 6.8% were ultimately admitted (n=86/1,259). 46.7% of patients had a non-dissolvable pack inserted by ED prior to referral to ENT (n=1,099/2,355). The discharge rates for ED patients and their subsequent re-presentation rates were as follows: non-dissolvable packs, 29.5% discharged (n=332/1125), 18.2% re-presented (n=60/330); dissolvable products, 71.1% discharged (n=488/686), 21.8% re-presented (n=106/486); cautery only, 89.2% discharged (n=247/277), 20.0% re-presented (n=49/245); and no intranasal intervention, 85.5% discharged (n=200/234), 15.2% re-presented (n=30/198). Univariable logistic regression showed that not being packed by ED, antiplatelet medications, failed cautery and recent epistaxis treatment were significant predictors of re-presentation within 10 days.

Conclusions: Management of acute epistaxis was notably affected during the initial peak of the pandemic, with a shift towards reduced admissions. This national audit highlights that many patients who may previously have been admitted to hospital may be safely discharged from the ED following acute epistaxis.