PTH-168 Organisation of an Acute upper Gastrointestinal Bleed Service in an average District General Hopsital
Notice bibliographique
Résumé
Introduction Acute Upper Gastrointestinal Bleed (AUGIB) continues to carry appreciable morbidity and mortality. Organisation and deliverance of emergency care incorporating therapeutic endoscopy is pivotal in the management of AUGIB. Recent British Society of Gastroenterology and NICE guidelines have recommended the introduction of a dedicated AUGIB service in institutions managing patients presenting with AUGIB. Since 2011 we set up a dedicated AUBIG service delivered by a team of gastroenterologists, surgeons and endoscopy support staff. The service currently runs 24 hrs a day and seven days a week. Methods Through clinical coding, endoscopy and theatre database we identified all cases of AUGIB for the first year of the service. Data was collected retrospectively from patient case notes, endoscopy reporting system and emergency theatre records. Results 77 cases of AUGIB were identified with gender distribution of 56% males and 44% females. The median age of presentation was 67 years (range 20–93 years). Most cases of AUGIB (71%) were acute admissions with the rest occurring among in-patients. A major improvement in the service is that all patients had at least one endoscopy during their presentation with most endoscopies (67%) performed within 24 hours or less and a further (26%) carried out 2–7 days. Endoscopies were performed by gastroenterologist (66%), surgeons (20%) and specialist registrar (14%). About a third (27%) had out of hours (OOH) emergency endoscopies and the remaining procedures were carried out in the dedicated in-patient lists. Majority (62%) of the OOH procedures were done at the weekends. A notable shortcoming was poor risk assessment (18%) at presentation although retrospective risk scoring revealed a median Rockall Score of 3 (range 1–5). At presentation only 8% of patients were admitted to the dedicated gastroenterology ward before the first endoscopy while the majority (52%) were managed initially on the acute medical wards and discharged or subsequently admitted to the gastroenterology ward. Conclusion The introduction of a dedicated service has improved the management of AUGIB in our hospital serving a population of 325,000 particularly during the OOH. The findings of this retrospective audit showed an AUGIB service collaborating medical gastroenterologists and surgeons is workable and sustainable in the setting of a district general hospital. To further improve the service a dedicated AUGIB clerking proforma incorporating Rockall risk score assessment is being considered. Disclosure of Interest None Declared.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».