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Management of ENT emergencies during the coronavirus disease 2019 pandemic

Published online by Cambridge University Press:  22 February 2021

J Stansfield*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Fairfield General Hospital, Northern Care Alliance NHS Group, Bury, UK
S Dobbs
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Fairfield General Hospital, Northern Care Alliance NHS Group, Bury, UK
R Harrison
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Fairfield General Hospital, Northern Care Alliance NHS Group, Bury, UK
K Lee
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Fairfield General Hospital, Northern Care Alliance NHS Group, Bury, UK
S Sharma
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Fairfield General Hospital, Northern Care Alliance NHS Group, Bury, UK
K Okour
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Fairfield General Hospital, Northern Care Alliance NHS Group, Bury, UK
S Agrawal
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Fairfield General Hospital, Northern Care Alliance NHS Group, Bury, UK
M S Miah
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Fairfield General Hospital, Northern Care Alliance NHS Group, Bury, UK
*
Author for correspondence: Mr Joseph Stansfield, Department of Otorhinolaryngology – Head and Neck Surgery, Fairfield General Hospital, Bury, UK E-mail: j.p.stansfield@doctors.org.uk

Abstract

Background

Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre.

Methods

After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019.

Results

An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients.

Conclusions

Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.

Type
Main Articles
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Mr J Stansfield takes responsibility for the integrity of the content of the paper

References

Zhou, P, Yang, XL, Wang, XG, Hu, B, Zhang, L, Zhang, W et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270–310.1038/s41586-020-2012-7CrossRefGoogle ScholarPubMed
Johns Hopkins Coronavirus Resource Center. Coronavirus Resource Centre. In: https://coronavirus.jhu.edu/ [1 September 2020]Google Scholar
Bann, DV, Patel, VA, Saddi, R, Gniady, JP, Goyal, N, McGinn, J et al. Impact of coronavirus (COVID-19) on otolaryngologic surgery: brief commentary. Head Neck 2020;42:1227–34CrossRefGoogle ScholarPubMed
Zou, L, Roun, F, Huang, M, Liang, L, Huang, H, Yu, J et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020;382:1177–9CrossRefGoogle ScholarPubMed
Chan, JY, Wong, EW, Lam, W. Practical aspects of otolaryngologic clinical services during the 2019 novel coronavirus epidemic: an experience in Hong Kong. JAMA Otolaryngol Head Neck Surg 2020;146:519–20CrossRefGoogle ScholarPubMed
ENT UK. Guidelines for changes in ENT during COVID-19 pandemic. In: https://www.entuk.org/entuk-guidelines-changes-ent-during-covid-19-pandemic [1 September 2020]Google Scholar
World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. In: https://apps.who.int/iris/bitstream/handle/10665/331601/WHO-2019-nCoV-Sci_Brief-Transmission_modes-2020.1-eng.pdf [1 September 2020]Google Scholar
Ahmed, K, Hayat, S, Dasgupta, P. Global challenges to urology practice during the COVID-19 pandemic. BJU Int 2020;125:E56CrossRefGoogle ScholarPubMed
Hampton, M, Clark, M, Baxter, I, Stevens, R, Flatt, E, Murray, J et al. The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases. Bone Jt Open 2020;1:137–4310.1302/2633-1462.15.BJO-2020-0028.R1CrossRefGoogle ScholarPubMed
Gov.UK. Emergency department: weekly bulletins for 2019. In: https://www.gov.uk/government/publications/emergency-department-weekly-bulletins-for-2019 [1 September 2020]Google Scholar
Gov.UK. Emergency department: weekly bulletins for 2020. In: https://www.gov.uk/government/publications/emergency-department-weekly-bulletins-for-2020 [1 September 2020]Google Scholar
Womack, JP, Kropa, J, Stabile, MJ. Epistaxis: outpatient management. Am Fam Physician 2020;98:240–5Google Scholar
Goljo, E, Dang, R, Iloreta, AM, Govindaraj, S. Cost of management in epistaxis admission: impact of patient and hospital characteristics. Laryngoscope 2020;125:2642–710.1002/lary.25374CrossRefGoogle Scholar
Goodyear, PW, Strachan, DR, Firth, AL. Intermittent self-nasal packing for intractable epistaxis in a patient with Ehlers-Danlos syndrome. J Laryngol Otol 2003;117:827–810.1258/002221503770716304CrossRefGoogle Scholar
Mehanna, HM, Al-Bahnaswi, L, White, A. National audit of the management of peritonsillar abscess. Postgrad Med J 2020;78:545–8CrossRefGoogle Scholar
Iqbal, SM, Hussain, A, Mughal, S, Khan, IZ, Khan, IA. Peritonsillar cellulitis and quinsy, clinical presentation and management. Pakistan Armed Forces Medical Journal 2020;59:298303Google Scholar
ENT UK. COVID-19 Tonsillitis & Quinsy Guidelines. In: https://www.entuk.org/entuk-guidelines-changes-ent-during-covid-19-pandemic [1 September 2020]Google Scholar
Al-Yaghchi, C, Cruise, A, Kapoor, K, Singh, A, Harcourt, J. Out-patient management of patients with a peritonsillar abscess. Clin Otolaryngol 2008;33:52–5CrossRefGoogle ScholarPubMed
Sichel, JY, Dano, I, Hocwald, E, Biron, A, Eliashar, R. Nonsurgical management of parapharyngeal space infections: a prospective study. Laryngoscope 2002;112:906–1010.1097/00005537-200205000-00023CrossRefGoogle ScholarPubMed
Powell, EL, Powell, J, Samuel, JR, Wilson, JA. A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation. J Antimicrob Chemother 2013;68:1941–50CrossRefGoogle ScholarPubMed
Garas, G, Ifeacho, S, Cetto, R, Arora, A, Tolley, N. Prospective audit on the outpatient management of patients with a peritonsillar abscess: closing the loop: how we do it. Clin Otolaryngol 2011;36:174–9CrossRefGoogle Scholar
Lewnard, JA, Lo, NC. Scientific and ethical basis for social-distancing interventions against COVID-19. Lancet Infect Dis 2020;20:631–3CrossRefGoogle ScholarPubMed
Brook, I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 2004;62:1545–50CrossRefGoogle ScholarPubMed
Passy, V. Pathogenesis of peritonsillar abscess. Laryngoscope 1994;104:185–90Google ScholarPubMed
Ellis, M, Ellis, ME. Infectious Diseases of the Respiratory Tract. Cambridge: Cambridge University Press, 1998CrossRefGoogle Scholar
Royal College of Emergency Medicine. RCEM – seriously ill or injured patients may be avoiding Emergency Departments due to Covid-19 fears. In: https://www.rcem.ac.uk/RCEM/News/News_2020/RCEM___seriously_ill_or_injured_patients_may_be_avoiding_Emergency_Departments_due_to_Covid-19_fears.aspx [1 September 2020]Google Scholar
Ting, DS, Carin, L, Dzau, V, Wong, TY. Digital technology and COVID-19. Nat Med 2020;26:459–61CrossRefGoogle ScholarPubMed
Luciani, LG, Mattevi, D, Cai, T, Giutsi, G, Proietti, S, Malossini, G. Teleurology in the time of Covid-19 pandemic: here to stay? Urology 2020;140:4610.1016/j.urology.2020.04.004CrossRefGoogle Scholar
Webster, P. Virtual health care in the era of COVID-19. Lancet 2020;395:1180–1CrossRefGoogle ScholarPubMed
Royal College of Surgeons of England. COVID-19: Good Practice for Surgeons and Surgical Teams. In: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/coronavirus/covid-19-good-practice-for-surgeons-and-surgical-teams/ [1 September 2020]Google Scholar
Al-Jabir, A, Kerwan, A, Nicola, M, Alsafi, Z, Khan, M, Sohrabi, C et al. Impact of the coronavirus (COVID-19) pandemic on surgical practice. Int J Surg 2020;79:168–79CrossRefGoogle ScholarPubMed
Chauhan, V, Galwankar, S, Arquilla, B, Garg, M, Somma, S, El-Menyar, A et al. Novel coronavirus (COVID 19): leveraging telemedicine to optimize care while minimizing exposures and viral transmission. J Emerg Trauma Shock 2020;13:20–4Google ScholarPubMed