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

ABSTRACT

Introduction: While there is anecdotal evidence that a SARSCoV- 2 (COVID-19) reverse transcription polymerase chain reaction screening nasopharyngeal swab confers an elevated risk of epistaxis, no studies substantiate this. We aim to assess the association between epistaxis and exposure to a provideradministered COVID-19 swab. Method(s) A paired-exposure crossover cohort design was used among all patients who received a single COVID-19 swab between April 2020 and March 2021. Occurrence of epistaxis was compared during the hazard period, the 7 days following the index COVID-19 swab, to the control period, the 7 days preceding the index COVID-19 swab. McNemar test was used to compare rates of control- and hazard-period epistaxis. Conditional logistic regression was used to evaluate sociodemographic and clinical risk factors for epistaxis. Result(s) A 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 in the hazard period (95% CI, 1.73, 2.12];P<.01). Older age (odds ratio [OR] 1.07;95% CI, 1.02, 1.75), Asian ancestry (OR 1.68;95% CI, 1.40, 2.02), men (OR 1.33;95% CI, 1.16, 1.54), anticoagulation/antiplatelet use (OR 2.88;95% CI, 2.11, 3.92), hypertension (OR 2.31;95% CI, 1.92, 2.78), and prior facial trauma (OR 1.63;95% CI, 1.21, 2.19) were associated with significantly increased odds of epistaxis during the hazard period (P<.01). Conclusion(s) COVID-19 nasal swabs are associated with increased risk of epistaxis. Physicians should provide additional counseling to patients, particularly those at highest risk, including those on anticoagulants/antiplatelets or with hypertension, prior to undergoing a COVID-19 nasal swab.