Use of endoscopy for management of acute upper gastrointestinal bleeding in the UK: results of a nationwide audit
Use of endoscopy for management of acute upper gastrointestinal bleeding in the UK: results of a nationwide audit
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DOI：
10.1136/gut.2008.174599
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发表时间：
2010-08-01
期刊：
影响因子：
24.5
通讯作者：
Palmer, Kelvin R.
中科院分区：
文献类型：
--
作者：
Hearnshaw, Sarah A.;Logan, Richard F. A.;Palmer, Kelvin R.
目的研究内镜检查在英国急性上消化道出血（AUGIB）中的应用，并与已发表的标准进行比较。评估英国AUGIB内镜检查服务的组织情况。研究结果与非工作时间（OOH）服务提供之间的关系。设计多中心横断面临床审计。设置接受AUGIB入院的所有英国医院。患者均为成人（>= 16岁）于2007年5月1日至6月30日期间接受AUGIB治疗。数据收集使用定制设计的基于网络的报告工具来收集有关患者特征、合并症和就诊时血液动力学状态的数据，以计算Rockall评分、内窥镜检查的使用和时机、治疗（包括内窥镜检查）、再出血和住院死亡率。邮寄问卷被用来收集数据的设施和服务organisation.Results数据6750例（中位年龄68岁），从208家医院进行了分析。74%的患者接受了住院内镜检查;其中50%发生在就诊后24小时内，82%发生在正常工作时间，3%发生在午夜至上午8点之间。在被认为是高风险的患者中（内镜检查前Rockall评分>= 5），只有55%的患者在24小时内接受内镜检查，14%的患者等待内镜检查时间>= 72小时。28%的患者存在再出血风险高的病变，其中74%接受了内镜治疗。13%的患者进一步出血明显，内镜检查患者的死亡率为7.4%（95% CI 6.7%至8.1%）。在52%的医院中，有一名顾问带领的非工作时间（OOH）内窥镜轮值表存在;在这些医院中，20%的首次内窥镜检查是在OOH进行的，而在没有OOH轮值表的医院中，这一比例为13%，内窥镜治疗更有可能进行（25%对21%，在没有OOH轮值表的医院中）。风险调整后的死亡率较高（1.21，p=0.10，（95%CI 0.96至1.51）），在医院没有这样的rotas.Conclusions审计发现继续延迟后，AUGIB和标准内镜治疗，特别是静脉曲张出血的使用不足，进行内镜检查。在有正式OOH内镜轮转的医院，患者接受内镜检查的时间更早，更有可能接受内镜治疗，死亡率可能更低。
Objectives To examine the use of endoscopy in the UK for acute upper gastrointestinal bleeding (AUGIB) and compare with published standards.To assess the organisation of endoscopy services for AUGIB in the UK.To examine the relationship between outcomes and out of hours (OOH) service provision.Design Multi-centre cross sectional clinical audit.Setting All UK hospitals accepting admissions with AUGIB.Patients All adults (>= 16 yrs) presenting with AUGIB between 1st May and 30th June 2007.Data Collection A custom designed web-based reporting tool was used to collect data on patient characteristics, comorbidity and haemodynamic status at presentation to calculate the Rockall score, use and timing of endoscopy, treatment including endoscopic, rebleeding and in-hospital mortality. A mailed questionnaire was used to collect data on facilities and service organisation.Results Data on 6750 patients (median age 68 years) were analysed from 208 hospitals. 74% underwent inpatient endoscopy; of these 50% took place within 24 h of presentation, 82% during normal working hours and 3% between midnight and 8 am. Of patients deemed high-risk (pre-endoscopy Rockall score >= 5) only 55% were endoscoped within 24 h and 14% waited >= 72 h for endoscopy. Lesions with a high risk of rebleeding were present in 28% of patients of whom 74% received endoscopic therapy. Further bleeding was evident in 13% and mortality in those endoscoped was 7.4% (95% CI 6.7% to 8.1%). In 52% of hospitals a consultant led out of hours (OOH) endoscopy rota existed; in these hospitals 20% of first endoscopies were performed OOH compared with 13% in those with no OOH rota and endoscopic therapy was more likely to be administered (25% vs 21% in hospitals with no OOH rota). The risk adjusted mortality ratio was higher (1.21, p=0.10, (95% CI 0.96 to 1.51)) in hospitals without such rotas.Conclusions This audit has found continuing delays in performing endoscopy after AUGIB and underutilisation of standard endoscopic therapy particularly for variceal bleeding. In hospitals with a formal OOH endoscopy rota patients received earlier endoscopy, were more likely to receive endoscopic therapy and may have a lower mortality.