Association Between Nasal Packing and 72-Hour Emergency Department Revisits in Adult Epistaxis: A Single-Center Retrospective Cohort Study

Objective: To evaluate whether nasal packing reduces 72-hour emergency department (ED) revisit rates in adult patients with epistaxis. Methods: We conducted a single-center retrospective cohort study of patients aged 18 years or older who visited the ED for epistaxis between April 1, 2019, and March 31, 2024. Patients who were admitted were excluded. The primary outcome was an ED revisit for epistaxis within 72 hours of discharge. To adjust for confounders, we used inverse probability of treatment weighting (IPTW) based on propensity scores, and performed sensitivity analysis using propensity score matching (PSM). Results: Among 948 patients analyzed, the unadjusted ED revisit rates were 5.1% in the nasal packing group and 6.1% in the no nasal packing group. In the IPTW-adjusted sample, the revisit rate remained lower in the nasal packing group (5.1% vs. 7.9%; OR, 0.63 [95% CI, 0.39 to 1.00]), though this difference did not reach statistical significance. Subgroup analyses showed a trend toward fewer revisits among patients with posterior bleeding (9.0% vs. 24.3%; OR, 0.31 [95% CI, 0.11 to 0.85]) and among those with ongoing bleeding at presentation (4.4% vs. 11.8%; OR, 0.35 [95% CI, 0.21 to 0.58]). A sensitivity analysis using PSM yielded similar results. Conclusion: Nasal packing may help reduce short-term ED revisits due to rebleeding in patients with epistaxis, especially in patients with posterior or active bleeding.