The Effect of After Hours Admission on Outcomes of Upper Gastrointestinal Bleeding
Notice bibliographique
Résumé
Purpose: Conflicting evidence exists regarding the effect of after-hours admission on outcomes of acute upper gastrointestinal bleeding (UGIB). This study aims to compare outcomes between patients admitted with acute UGIB during regular working hours vs. after hours and to determine if outcomes differ depending on timing of endoscopy or availability of an endoscopy nurse. Methods: A retrospective chart review was conducted for all patients presenting with acute UGIB in 2 hospitals from January to December 2010 in Hamilton, Ontario. Patients were categorized according to time of admission as either during regular working hours (ON hours) or after-hours (OFF hours). Data on demographics, clinical presentation, endoscopic findings and interventions, and nurse availability for procedure were collected. Rockall scores were calculated for all patients. Differences in mortality, rebleeding, need for surgery or radiological intervention, repeat endoscopy, and length of stay (LOS) between patients admitted during ON vs. OFF hours were evaluated by univariable and multivariable analyses. Results: 199 UGIB admissions were included (mean age 66.4, range 19 to 94), with 34.7% admitted during ON hours and 65.3% during OFF hours. The majority of patients (95.5%) had non-variceal UGI bleeding. Endoscopy was performed within 24 hours in 66.3% of patients. No statistically significant difference was found in time to endoscopy between ON vs. OFF hours admission (mean 28.1 vs. 23.4 hours; P=0.26). There was also no statistically significant difference in the individual outcomes between ON vs. OFF hours admission. After adjusting for pre-endoscopic Rockall score, significantly more patients admitted during OFF hours had the composite outcome (at least one of death, rebleeding, need for surgery or radiological intervention, or repeat endoscopy) compared to patients admitted during ON hours (OR 2.46, 95% CI 1.01 to 5.71; P=0.036). In patients with the composite outcome, time to endoscopy was significantly shorter (15.5 vs. 27.5 hours, p=0.001), and the LOS was significantly longer (7.4 vs. 4.4 days; p=0.002). Only 13 patients underwent endoscopy in the absence of an endoscopy nurse. During OFF hours, the presence of an endoscopy nurse during procedure did not significantly reduce the rate of the composite outcome (50.0% vs. 23.3%; P=0.12) or the individual outcome. Conclusion: In this retrospective study of patients with acute UGIB in a Canadian setting with no significant delay in endoscopy, after hours admission was associated with poor overall outcomes independent of the availability of an endoscopy nurse. Further research is required to determine the causes and relationship to resource availability and staffing.
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 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| 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 ».