ICU care for patients with gastrointestinal bleeding: impact on cost and outcome

Hampers, M. J.; Surgenor, Stephen D.; Spanjian, K.; Clerico, Terri; Corwin, Howard L.

doi:10.3109/tcic.13.2-3.109.113

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…Over the years, efforts have, instead, focused on immediate resuscitation measures in specialised areas including high dependency units,19 specialist gastroenterology services,20 intensive care units21 22 or, more recently, in dedicated upper-gastrointestinal haemorrhage units 23. The long-term outcomes of care in such facilities are not clear.…”

Section: Discussionmentioning

confidence: 99%

Falling mortality when adjusted for comorbidity in upper gastrointestinal bleeding: relevance of multi-disciplinary care

Taha

Saffouri

McCloskey

et al. 2014

Frontline Gastroenterol

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ObjectivesThe understanding of changes in comorbidity might improve the management of upper gastrointestinal bleeding (UGIB); such changes might not be detectable in short-term studies. We aimed to study UGIB mortality as adjusted for comorbidity and the trends in risk scores over a 14-year period.MethodsPatients presenting with UGIB to a single institution, 1996–2010, were assessed. Those with multiple comorbidities were managed in a multi-disciplinary care unit since 2000. Trends with time were assessed using logistic regression, including those for Charlson comorbidity score, the complete Rockall score and 30-day mortality.Results2669 patients were included. The Charlson comorbidity score increased significantly with time: the odds of a high (3+) score increasing at a relative rate of 4.4% a year (OR 1.044; p<0.001). The overall 30-day mortality was 4.9% and inpatient mortality was 7.1%; these showed no relationship with time. When adjusted for the increasing comorbidity, the odds of death decreased significantly at a relative rate of 4.5% per year (p=0.038). After the introduction of multi-disciplinary care, the raw mortality OR was 0.680 (p=0.08), and adjusted for comorbidity it was 0.566 (p=0.013).Conclusions30-day mortality decreased when adjusted for the rising comorbidity in UGIB; whether this is related to the introduction of multi-disciplinary care needs to be considered.

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Section: Discussionmentioning

confidence: 99%

Falling mortality when adjusted for comorbidity in upper gastrointestinal bleeding: relevance of multi-disciplinary care

Taha

Saffouri

McCloskey

et al. 2014

Frontline Gastroenterol

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“…Haemodynamic instability per se should not be the sole determinant for critical care admission. 33 In cases of ongoing haemodynamic instability despite adequate resuscitative efforts, activation of the major haemorrhage protocol should be considered in addition to early referral to a critical care specialist in order to optimise circulatory management. 32 34 We suggest that platelets should be given in active AugIb with a platelet count ≤50 × 10 9 /L, as per major haemorrhage protocols Level of evidence: Very low Level of recommendation: Weak Agreement: 90% Bundle recommendation: Keep platelet count >50 (included as part of major haemorrhage protocol, therefore no separate statement required)…”

Section: We Recommend That Red Blood Cell (Rbc) Transfusion Should Fomentioning

confidence: 99%

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

Siau¹,

Hearnshaw

Stanley

et al. 2020

Frontline Gastroenterol

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Medical care bundles improve standards of care and patient outcomes. Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency which has been consistently associated with suboptimal care. We aimed to develop a multisociety care bundle centred on the early management of AUGIB.Commissioned by the British Society of Gastroenterology (BSG), a UK multisociety task force was assembled to produce an evidence-based and consensus-based care bundle detailing key interventions to be performed within 24 hours of presentation with AUGIB. A modified Delphi process was conducted with stakeholder representation from BSG, Association of Upper Gastrointestinal Surgeons, Society for Acute Medicine and the National Blood Transfusion Service of the UK. A formal literature search was conducted and international AUGIB guidelines reviewed. Evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation tool and statements were formulated and subjected to anonymous electronic voting to achieve consensus. Accepted statements were eligible for incorporation into the final bundle after a separate round of voting. The final version of the care bundle was reviewed by the BSG Clinical Services and Standards Committee and approved by all stakeholder groups.Consensus was reached on 19 statements; these culminated in 14 corresponding care bundle items, contained within 6 management domains: Recognition, Resuscitation, Risk assessment, Rx (Treatment), Refer and Review.A multisociety care bundle for AUGIB has been developed to facilitate timely delivery of evidence-based interventions and drive quality improvement and patient outcomes in AUGIB.

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OTU-19 Early clinical management of acute upper gastrointestinal bleeding: a UK multisociety consensus care bundle

et al. 2019

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Conclusion This study showed there was no statistically significant difference in the outcomes of rebleeding, need for surgery, mortality or length of hospital stay when PPIs were administered intermittently compared to by infusion. Conservative margins of non-inferiority were used due to the potential clinical implications, despite this non-inferiority was shown with regard to re-bleeding and mortality. The assessment of the quality of the evidence supports the validity of the findings. Given the delivery of PPI via infusion is more costly, timely and inconvenient for patients, the determination of non-inferiority supports a change in practice. OTU-19 EARLY CLINICAL MANAGEMENT OF ACUTE UPPER

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ICU care for patients with gastrointestinal bleeding: impact on cost and outcome

Cited by 4 publications

References 8 publications

Falling mortality when adjusted for comorbidity in upper gastrointestinal bleeding: relevance of multi-disciplinary care

Falling mortality when adjusted for comorbidity in upper gastrointestinal bleeding: relevance of multi-disciplinary care

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

OTU-19 Early clinical management of acute upper gastrointestinal bleeding: a UK multisociety consensus care bundle

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