Are Patients Hospitalized With Cirrhosis and Ascites Receiving Appropriate Diagnostic Paracentesis?
Notice bibliographique
Résumé
Introduction: Ascites is the most common complication of cirrhosis, and is associated with increased mortality. Diagnostic paracentesis is recommended for patients who are admitted to the hospital with ascites. However, it is unknown if diagnostic paracentesis in Canadian teaching hospitals are done according to recommended guidelines. We analyzed the rate of paracentesis, determined barriers for not performing paracentesis, and the association of not performing diagnostic paracentesis with mortality. Methods: We conducted a retrospective chart review of inpatient records from January 2012 to May 2014 at 2 sites of Hamilton Health Sciences. We used electronic medical records to identify patients with cirrhosis and ascites who were admitted with a primary or secondary diagnosis of ascites, spontaneous bacterial peritonitis, or hepatic encephalopathy. All patients have to have a secondary diagnosis of cirrhosis. Primary point of interest was the performance of diagnostic paracentesis. We determined barriers for not performing and delaying paracentesis >1 day after admission. We used multiple logistic regression to study the association between age, sex, Charlson score (comorbidity score), model of endstage liver disease (MELD) score, and weekend admission for patients who received and did not receive paracentesis. Mortality and hospital stay (outcomes) were compared for those who received and did not receive paracentesis. Results: Of 162 eligible admissions, 82 (50.6%; 95% CI 42.7- 58.6%) received paracentesis. Seventyseven percent (63) of paracenteses occurred early (<1 day after admission). After adjusting for covariates, MELD was the only predictor that was significantly associated with performance of paracentesis (p=0.022). In patients who did not receive paracentesis, 46/80 (57.5%) had no documented reason for not receiving paracentesis. In patients who received delayed paracentesis, 42.1% (8) was related to seeking ultrasound (US) guidance. The mean hospital stay was longer with patients who received paracentesis (8.2) compared to those who did not receive paracentesis (7.1). In-hospital mortality was slightly higher with patients underwent paracentesis 9/82 (11%) compared to those who did not undergo paracentesis 6/80 (7.5%). Neither met statistical significance. Conclusion: In these 2 Canadian teaching centers, paracentesis was underused for patients admitted with ascites and cirrhosis. There was no clear documented reason for not receiving paracentesis in many patients. We found an increased reliance on US guidance resulted in delayed paracentesis. MELD score is the only predictor identified for receiving paracentesis. Larger studies needed to determine the effect of not performing paracentesis on mortality.
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 | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| 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 ».