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Multicenter Study
. 2019 Mar;7(2):199-209.
doi: 10.1177/2050640618811491. Epub 2018 Oct 28.

Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit

Keith Siau  1   2 , James Hodson  3 , Richard Ingram  4 , Andrew Baxter  4 , Monika M Widlak  2 , Caroline Sharratt  4 , Graham M Baker  2 , Tom Troth  2 , Ben Hicken  2 , Faraz Tahir  2 , Malik Magrabi  2 , Nouman Yousaf  2 , Claire Grant  4 , Dennis Poon  4 , Hesham Khalil  4 , Hui Lin Lee  4 , Jonathan R White  4 , Huey Tan  4 , Syazeddy Samani  4 , Patricia Hooper  4 , Saeed Ahmed  4 , Muhammad Amin  4 , Sara Mahgoub  2 , Khayal Asghar  2 , Farique Leet  2 , Matthew J Harborne  2 , Beata Polewiczowska  2 , Sheeba Khan  2 , Muhammad R Anjum  2 , Michael McFarlane  2 , Ella Mozdiak  2 , Lauren D O'Flynn  2 , Ilona C Blee  2 , Rachel M Molyneux  2 , Ashok Kurian  2 , Syed N Abbas  2 , Abdullah Abbasi  2 , Aadil Karim  2 , Asif Yasin  2 , Fawad Khattak  2 , Josephine White  2 , Ruhina Ahmed  2 , James A Morgan  2 , Lance Alleyne  2 , Mohamed A Alam  4 , Naaventhan Palaniyappan  4 , Victoria J Rodger  4 , Paramvir Sawhney  4 , Nasar Aslam  4 , Theodore Okeke  4 , Adam Lawson  4 , Danny Cheung  2 , Jeremy P Reid  2 , Ashish Awasthi  2 , Mark R Anderson  2 , Joe R Timothy  2 , Sanjeev Pattni  4 , Saqib Ahmad  4 , Gillian Townson  2 , Jeremy Shearman  2 , Vanja Giljaca  2 , Matthew J Brookes  2 , Ben R Disney  2 , Neil Guha  4 , Titus Thomas  4 , Anthony Norman  4 , Peter Wurm  4 , Ashit Shah  2 , Neil C Fisher  2 , Sauid Ishaq  2 , Giles Major  4
Affiliations
Multicenter Study

Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit

Keith Siau et al. United European Gastroenterol J. 2019 Mar.

Abstract

Background: Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission).

Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.

Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2 h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1 h (IQR 3.7-18.1) and 6.7 h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0-87.5%, p = 0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p = 0.004), but not 30-d mortality (p = 0.344).

Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.

Keywords: Upper gastrointestinal bleeding; endoscopy; haemorrhage; quality; time to endoscopy.

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Figures

Figure 1.
Figure 1.
Endoscopic diagnoses.
Figure 2.
Figure 2.
Time to endoscopy (h) for each participating centre. *Denotes centres achieving the JAG standard of early endoscopy in 75% + of patients.
Figure 3.
Figure 3.
Kaplan-Meier plots illustrating rates of 30-d survival (a) and readmission (b), stratified by time to endoscopy.
See this image and copyright information in PMC

Comment in

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