Objectives
To investigate factors affecting the haemostatic success of non‐dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED).
Design
Prospective cohort study.
Setting
A nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30‐day period.
Participants
Patients 16 years or older, presenting to the ED with acute epistaxis managed with non‐dissolvable intranasal packs.
Main outcome measures
The primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology.
Results
A cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter‐duration packs (89.9% vs. 84.3%, χ2 P = .028). A patient survey supported longer packing duration. The most significant predictors of treatment failure were shorter packing duration (Odds Ratio (OR) = 2.3; 95% Confidence Interval (CI) = 1.4‐3.8), alongside ischaemic heart disease (OR = 1.9; 95% CI = 1.1‐3.3), normal admission haemoglobin (OR = 2.0; 95% CI = 1.2‐3.4) and no attempt at cautery following pack removal (OR = 2.5; 95% CI = 1.4‐4.2).
Conclusions
The majority of epistaxis patients are packed by the ED prior to referral to ENT. Once inserted, nasal packs are highly successful, with data supporting the British Rhinological Society guidance of maintaining nasal packs for around 24 hours. Further work is needed to explore alternatives to non‐dissolvable intranasal packs to improve patient experience in epistaxis.
The main determinant of the growth of Gulf Cooperation Council (GCC) countries is inward foreign direct investment stock (FDI). The paper shows the effects of economic growth, cost of living, Economic Freedom Indices, global oil price, and construction value-added on the inward foreign direct investment stock in GCC in the long term and short term for an unbalanced data period of study from 1996 to 2020(Bahrain, Kuwait, Oman, Saudi Arabia, and the United Arab Emirates) and Qatar from 1999 to 2020. We use the PMG ARDL model to have a long-run and short-run estimate between these variables in the gulf council region. Empirical results evidence positive correlation that economic growth and construction industry volumes and cost of living and economic freedom indices have an inverse relationship in long term on regional FDI stock. At the same time, results confirm that there is Cross-sectional dependence among these countries of GCC.
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