The Effect of After Hours Admission on Outcomes of Upper Gastrointestinal Bleeding
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| 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".