A45 REAL LIFE MANAGEMENT OF PATIENTS PRESENTING WITH UPPER GI BLEEDING IN A TERTIARY CARE EMERGENCY DEPARTMENT - ARE WE DELIVERING THE STANDARD OF CARE?
Bibliographic record
Abstract
Upper gastrointestinal bleeding (UGIB) is a common Emergency Department (ED) presentation. Early endoscopic intervention, supported by Glasgow Blatchford Score (GBS) severity, has been shown to reduce re-bleeding rates and lower the morbidity and mortality. However, emergent endoscopy is not necessary for all patients. Low-risk patients can be managed through outpatient follow-up. Other important management issues such as threshold for blood transfusion (Hb <70) and use of oral or intravenous proton pump inhibitor (PPI) therapy also warrant study. The aim of this study was to review the timing and appropriateness of endoscopy and supportive management such as need for blood transfusion (Hb <70) and proton pump inhibitor (PPI) use in a real life tertiary care site setting compared to standard of care. A retrospective comparative cohort study was conducted to examine the management of patients presenting with UGIB to the University of Alberta Hospital ED, between January 1 and December 31, 2016 using a chart review methodology. TANDEM and EDIS databases were queried to identify patients using specified ICD 10 codes and CEDIS presenting complaints of vomiting blood or blood in stool/melena. Outcome measures included: patient characteristics, acuity scores including the Glasgow Blanchard Score (GBS) to determine appropriateness for admission and timing of endoscopic intervention, diagnoses, need for blood transfusions and use of oral or intravenous PPIs. Data were entered into a REDCap database. Standard statistical tests were used for data analysis. A total of 200 patients, 59% male (118/200), mean age 59 years (range 18 - 92 years) were included. The average GBS was 8.25. 79% of patients (157/200) underwent endoscopy during the hospital visit: 26% (9/35) of patients with GBS score of 0 to 2 and 78% (129/165) patients with GBS ≥ 3 underwent endoscopy within 24 hours. The two most common endoscopic diagnoses were peptic ulcers (39%, 61/157) and esophageal/gastric varices (18%, 28/157), while 14% (22/157) of endoscopies had a normal diagnosis or mild gastritis. 87 % of patients (174/200) were given IV or oral PPI in the ED whereas the remaining 13% (26/200) did not receive PPI. 37% of patients (74/200) received blood transfusion, but only 53% (39/74) were administered based on the 70 g/L threshold while in 39% (29/74) patients the less restrictive threshold of 90 g/L was used. A majority of UGIB patients presenting to a tertiary hospital ED appropriately received endoscopy within 24 hours based on a GBS score ≥ 3. PPI use was appropriate but a significant proportion of patients received inappropriate blood transfusions. Emergency Strategic Clinical Network (ESCN), Alberta Health Services
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".