Acute variceal bleeding and out-of-hours endoscopy: Evaluation of an emergency care setting according to Baveno VI guidelines adherence
| Autor: | Pedro Pinto, Tiago Pereira Guedes, Mónica Garrido, Daniela Falcão, Maria Inês Novo, Isabel Pedroto, Marta Rocha, Teresa Moreira, Luís Maia, José Manuel Ferreira, Joana Alves da Silva |
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| Rok vydání: | 2021 |
| Předmět: |
Liver Cirrhosis
Male Variceal bleeding medicine.medical_specialty Esophageal and Gastric Varices Endoscopy Gastrointestinal Care setting Out of hours After-Hours Care Emergency medical services Humans Medicine Aged Retrospective Studies Portugal Hepatology medicine.diagnostic_test business.industry Esophagogastroduodenoscopy Gastroenterology Middle Aged medicine.disease Endoscopy Hospitalization Emergency medicine Portal hypertension Female Guideline Adherence Emergency Service Hospital Gastrointestinal Hemorrhage business Varices |
| Zdroj: | Digestive and Liver Disease. 53:1320-1326 |
| ISSN: | 1590-8658 |
| DOI: | 10.1016/j.dld.2021.07.004 |
| Popis: | Background The extent to which patients with acute variceal bleeding (AVB) receive recommended care is largely unknown. Aim to evaluate the adherence of the 4 major Baveno VI recommendations [vasoactive agents, prophylactic antibiotic, esophagogastroduodenoscopy (EGD) within 12 hours, endoscopic variceal ligation (EVL)] as a marker of quality of an emergency model. Methods Retrospective evaluation of AVB admissions to a tertiary centre in which endoscopy was available 24hours-a-day, with a regional out-of-hours service at night (the furthest hospital is 200Km away). Patients were divided in directly admitted or transferred from other centres. Results 210 AVB patients were included; 101 (48.1%) were directly admitted. The majority of patients were submitted to vasoactive agents (85.7%) and prophylactic antibiotics (79%) before EGD. In 178 patients (84.8%) endoscopy was performed within 12h and EVL was the procedure of choice in 116 (74.8%) (only oesophageal varices). No significant differences were observed between directly admitted and transferred patients in adherence rates. Overall rebleeding rate was 8.6%, in-hospital mortality 11.4% and 6-week mortality 20%. Conclusion Adherence to quality metrics was high which might have played a vital role for reported outcomes. These results suggest that this model of care, provides accessibility and equity in access to urgent endoscopy. |
| Databáze: | OpenAIRE |
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