Background
The aim of this study was to investigate whether changes in practice during the COVID‐19 pandemic altered clinical presentation characteristics among adults with bacterial throat infections.
Methods
A retrospective cohort study was conducted that included adult patients presenting with bacterial oropharyngeal infections to a tertiary level hospital in Melbourne, Australia. All patients presenting during the first phase of COVID‐19 lockdown in Melbourne (1st April– 1st July in 2020), and those from the same period 12‐months prior, were included.
Results
There were fewer presentations of bacterial throat infections during the pandemic period compared to the same time 1 year prior. There was a significantly reduced proportion of patients on oral antibiotics prior to their presentation in 2020, as compared to the same period 12‐months earlier (30% vs. 50%, respectively;
P
< 0.01), as well as a significant increase in the length of time patients were symptomatic before presenting to hospital (5 days vs. 4 days, respectively;
P
< 0.01). Despite this, there was no significant increase in the number of representations post discharge from hospital, or the length of hospital admission.
Conclusion
The overall number of patients presenting with tonsillitis, pharyngitis, peritonsillar abscess and deep neck space infection were reduced during the pandemic period. Patients experienced symptoms for a longer period of time and fewer were on antimicrobial therapy prior to presentation. This study highlights a shift towards delayed patient presentation and reduced oral antibiotic commencement in cases of oropharyngeal infections as a result of the COVID‐19 pandemic.
Background
Risk factors and outcomes associated with severe epistaxis are not well understood. This study explores the associations between epistaxis severity, comorbidities, use of antiplatelets or anticoagulants and management outcomes.
Methods
This is a retrospective cross‐sectional study of all epistaxis cases presenting to the emergency department at a tertiary academic hospital from January 2016 to December 2019. Epistaxis severity was defined as mild (no intervention), moderate (required cautery and/or packing) and severe (clinical instability with reversal products, surgical or radiological intervention). Univariable and multivariable regression analyses were undertaken, with risk factors and management outcomes analysed according to severity.
Results
A total of 543 patients with epistaxis (54.2% male, mean age 74.4 ± 15.7 years) were included in this study, with 14.7% (80) having severe epistaxis. Of these presentations 216 (39.8%) were on antiplatelets, while 207 (38.1%) were on anticoagulants. In univariate analyses, clopidogrel use, hereditary haemorrhagic telangiectasia (HHT), haematological malignancy, bleeding disorders and chronic liver disease (CLD) were associated with moderate to severe epistaxis (P < 0.05), while the use of rivaroxaban was inversely associated severity (P = 0.002). Only HHT, haematological malignancy and CLD remained significant in multivariate models. Cautery as first‐line management was infrequently utilized while anticoagulation was frequently withheld. A longer length of stay (1.1 days vs. 4.3 days; P < 0.001) and higher 2‐week readmission rates (2.2% vs. 12.5%; P < 0.001) were noted with severe epistaxis compared with mild presentations.
Conclusion
Epistaxis severity is associated with certain clinical conditions and poor outcomes. Despite recommended guidelines, variations in first‐line management were evident.
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