(1222) Early Nasal Endoscopy After Epistaxis Improves Clinical Outcomes and Healthcare Utilization

Introduction: Current clinical guidelines recommend otolaryngology (ENT) follow-up after epistaxis for at-risk patients. However, the impact of early ENT follow-up with nasal endoscopy after emergency department (ED) presentation for epistaxis on subsequent healthcare utilization remains unclear.

Methods: This retrospective study queried de-identified patient records from 70 Healthcare organizations in the US TriNetX Collaborative Network to identify adult patients (≥ 18 years) with an ED epistaxis visit from 01/01/2015 - 12/31/2025. Patients with an instance of epistaxis (ICD-10 R04.0) on the same day of ED visit were included, and those without were excluded. For the early ENT follow-up cohort, CPT code 31231 for nasal endoscopy (NE) was used as a proxy to identify the presence of any ENT visit 1 to 7 days after initial ED epistaxis visit. Patients with an absence of CPT 31231 in this period were included in the late ENT follow-up cohort. Propensity-score matching (PSM) was performed 1:1 using a greedy-nearest neighbor algorithm for age, sex, race, ethnicity, and comorbidities, with a 0.1 pooled caliper. The primary outcomes of this study are healthcare utilization and risk of transfusion, 8 - 90 days after initial ED epistaxis visit.

Results: Post-PSM, 1,394 patients were matched in both the early ENT follow-up cohort (mean [SD] age, 58.7 [16.4] years, 798 male [57.2%]) and the late ENT follow-up cohort (mean [SD] age, 59.2 [16.9] years, 807 male [57.9%]). Decreased risk for ED visits (Risk Ratio, RR: 0.48, 95% CI, 0.38-0.59), intensive care unit (ICU) admission (RR: 0.45, 95% CI, 0.25-0.79), hospital admission (RR: 0.45, 95% CI, 0.34-0.59), and transfusion (RR: 0.29, 95% CI, 0.15-0.59) were observed in the early ENT follow-up cohort.

Conclusions: Early ENT follow-up with NE after ED epistaxis was associated with reduced healthcare utilization and decreased risk of transfusion.