Providing Evidence for Dogma: Risk of Epistaxis After COVID-19 Nasal-Screening Swab

ObjectiveThere is anecdotal evidence SARS-CoV-2 (COVID) RT-PCR screening nasal swabs confer an elevated epistaxis risk. We aimed to assess the association between epistaxis and exposure to a COVID nasal swab. Study DesignA matched pairs design was used. SettingThe study was performed in a single, integrated healthcare system. MethodsAll patients who received a single COVID nasal swab at our institution between April 2020 and March 2021 were included. McNemar's test was used to compare rates of epistaxis between the 7 days following the index COVID swab (hazard period), and the 7 days preceding the index COVID swab (control period). Conditional logistic regression was used to evaluate sociodemographic and clinical risk factors for epistaxis. ResultsA total of 827,987 participants were included, with 1047 epistaxis encounters. The prevalence of epistaxis during the hazard and control periods were 0.08% and 0.04%, respectively. Swab exposure was associated with 1.92-fold odds of epistaxis during the hazard period (95% confidence interval [1.73, 2.12]). Older age, Asian/Pacific Islander (PI) (compared to white), male sex, hypertension, prior facial trauma, and warfarin or direct-acting oral anticoagulant use were also associated with significantly increased odds of epistaxis (p <= 0.01). ConclusionCOVID nasal swabs are associated with increased odds of epistaxis. Physicians should counsel patients, particularly those at the highest risk, including a history of prior facial trauma, anticoagulants/antiplatelets, or hypertension.

Automated summary

This study aimed to assess the association between COVID nasal swab testing and epistaxis. The results showed that patients who underwent nasal swab testing had a higher risk of epistaxis within 7 days after the test. Other risk factors associated with epistaxis included older age, Asian/Pacific Islander ethnicity, male sex, hypertension, prior facial trauma, and the use of warfarin or direct-acting oral anticoagulants.