Effect of Physician Specialty and Call Back Endoscopy Teams in Non-Variceal Upper Gastrointestinal Bleeding: A Comparison between Two Health Regions
Notice bibliographique
Résumé
Purpose: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency and a frequent cause for admission to Canadian hospitals. There is significant morbidity and mortality associated with these admissions. In certain Canadian health regions, many NVUGIB are admitted to general surgical wards and many do not have call back endoscopy teams. The effect of these factors on mortality and re-bleeding is unknown. Methods: We examined two similar health regions which differed in the management of NVUGIB. The Saskatoon Health Region (SHR) has no formal call back endoscopy team and 40% of NVUGIB patients were admitted to a general surgery ward. In contrast, the Regina Qu'Appelle Health Region (RQHR) has a formal call back team and 80% of patients are admitted to a GI ward. ICD-10 codes were used to identify patients with a primary or secondary diagnosis of NVUGIB admitted to the SHR or RQHR between January 2008 and February 2010. The primary outcomes of interest were mortality and 30-day re-bleeding rates. Primary outcomes were also stratified by health region, endoscopist specialty, and weekend admission. Descriptive statistics using mean, medians and ranges were used to describe demographic and patient variables. Group comparisons of proportions and means were performed using Chi-square analysis and Student's t-test. Results: The mortality rate across both health regions for NVUGIB was 12.4% with 15.8% experiencing rebleeding and 3.6% readmitted within thirty days due to re-bleeding. There was no significant mortality difference between health regions (14.7% vs. 10.1% p=0.1), but there was a significant increase in rebleeding (23.1% vs. 8.5% p=<0.001; CI 0.17-0.30) and readmission (6.9% vs. 0.6% p=0.002; CI 0.03-0.11) in the SHR. This was unchanged when adjusted for age and comorbidities by logistic regression with an odds ratio of 3.11 (p=0.001; CI 1.6-5.9). Mortality and rebleeding rates were similar independent of endoscopist specialty. Readmission rates were higher across both health regions if admitted to a general surgeon versus gastroenterologist (7.5% vs. 1.9% p=0.01; CI 0.89-0.99). There was no significant weekend effect. Early endoscopy (<24 hrs) was significantly more frequent within the RQHR (84.7% vs. 65.0%; p<0.001; CI 1.13-1.36) and if the attending physician was a gastroenterologist (80.5% vs. 65.1% p=0.009; CI 1.13-1.36). Conclusion: Mortality rates across both health regions were higher than the national average, but not statistically different between the two. The presence of gastroenterologists admitting a larger proportion of NVUGIB and formal call back teams was associated with decreased rebleeding rates, readmission rates, and increased rates of early endoscopy.
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 machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 source (Gemma direct ou Codex distillé), 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 ».