(1235) High-Acuity Epistaxis Transfers: National Trends from the National Inpatient Sample (NIS) Database

Introduction: Epistaxis is a common otolaryngologic emergency and a frequent reason for emergency department evaluation. While the majority of cases can be managed with conservative measures, a smaller subset may require advanced interventions, such as posterior packing or embolization, which drive hospital transfers. Factors associated with high-acuity transfer outcomes remain incompletely characterized.

Methods: This is a retrospective cohort study of the National Inpatient Sample (NIS) database from 2018-2022, evaluating transfer-in patients with principal diagnosis of epistaxis (ICD-10-CM: R04.0). Patients discharged to another short-term hospital or facility were excluded. Indicators of high acuity transfers evaluated in this study included patients who underwent an endoscopic intervention (e.g., endoscopic cautery; ICD-10-PCS: 093K8ZZ) or an embolization procedure (ICD-10-PCS prefixes: 03LM*/03LN*/03LR*). Multiple survey-weighted logistic regressions evaluated factors associated with receiving each intervention, adjusting for year, patient demographics, comorbidities, and hospital characteristics.

Results: Among 854 transfer-in patients, 203 (23.8%) were classified as high-acuity based on procedures received. 47.3% (n = 96) of this cohort required endoscopic intervention, while 52.7% (n = 107) underwent embolization. Comorbidity count was associated with a decreased likelihood of receiving embolization control compared with endoscopic intervention (OR 0.43 per comorbidity, p = 0.043). Endoscopic intervention has had an increasing trend since 2018 (OR 1.21 per year, p = 0.011). Additionally, patients with private insurance were more likely to receive an endoscopic intervention than those with Medicare, regardless of age (OR 2.38, p = 0.004).

Conclusions: Among high-acuity transfers for epistaxis, embolization procedure rates varied by comorbidity burden compared with endoscopic procedures. However, region and insurance type were significantly associated with specific interventions, suggesting that access and practice variation may also influence treatment choice.