Use of Intravenous Histamine-2 Receptor Antagonists and Proton Pump Inhibitors in an ICU Setting and Predictors of Inappropriate Prescribing Upon Discharge: 2011 ACG Presidential Poster
Bibliographic record
Abstract
Purpose: H2 receptor antagonists (H2RAs) are usually used for prophylaxis, although proton pump inhibitors (PPIs) seem to have evolved into first line therapy in an increasing proportion of patients. Unfortunately, gastric acid suppressants initially prescribed are frequently prescribed inappropriately on discharge from intensive care units both on transfer and at discharge from hospital. The purpose of this study was to audit the use of gastric acid suppression in our intensive care unit and to evaluate differences between H2RAs and PPIs in terms of prescription patterns at discharge. Methods: Chart review was conducted of all patients admitted to the intensive care unit and subsequently transferred to a medical floor at the Montreal General Hospital between December 1 2009 and May 31 2010. Descriptive data are summarized as proportions or means. Multivariable analysis was completed to determine predictors of inappropriate prescribing on discharge. P value significance was set at 0.05. Results: 125 consecutive patients were analyzed. The mean age was 64.4 (+/-17.3) years and 53.8% (+/-4.5%) were female. 68.6% (+/-4.2%) were mechanically ventilated for over 48 hours. Gastric acid suppression was prescribed for 70.2% (CI95 62.0-78.5%) of the patients during their ICU stay (PPI: 34.4%; H2 receptor antagonist: 26.4%; Both 7.4%). 96.5% (CI95 92.5-100%) of gastric acid suppression prescribed in the ICU were for appropriate indications. GI bleed while in the ICU (suspected or confirmed) was present in 28.7% of the patients. Proton pump inhibitors were more often used in patients with GI bleeds than H2 receptor antagonists (93.5% (CI95: 84.9-100%) versus 19.4 (CI95: 5.4-33.3%) p <0.0001). Of the patients started on gastric acid suppression in the ICU, 40.0% (CI95 29.4-50.6%) were discontinued in the ICU and a further 5.9% (CI95; 0, 8-10.9%) were discontinued on the medical ward. 60.6% of patients had an appropriate prescription for gastric acid suppression at hospital discharge. Proton pump inhibitors were less likely to be discontinued than H2 receptor antagonists (17.5% (CI95: 5.7-29.2%) versus 90.0% (CI95: 80.7-99.2%) p <0.0001). In multivariate analysis the prescription of a proton pump inhibitor in the ICU was associated with the inappropriate prescription of the proton pump inhibitor upon hospital discharge (odds ratio 0.28 (p = 0.017 (CI95 0.096-0.79)). This effect persisted even if patients with GI bleeds were excluded in the analysis. Conclusion: Proton pump inhibitors and H2 receptor antagonists were prescribed appropriately in the ICU for gastric acid suppression. However, proton pump inhibitors were more likely to be inappropriately continued upon hospital discharge.
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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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| 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".