Prospective evaluation of a clinical guideline recommending early patients discharge in bleeding peptic ulcer.
J Gastroenterol Hepatol. 2010 Sep;25(9):1525-9
Authors: Chaparro M, Barbero A, MartÃn L, Esteban C, Espinosa L, de la Morena F, SÃ¡nchez A, MartÃn I, Santander C, Moreno-Otero R, Gisbert JP
Abstract Background and Aim: To validate an early discharge policy in patients admitted with upper gastrointestinal bleeding (UGIB) due to ulcers. Methods: Patients with gastroduodenal ulcer or erosive gastritis/duodenitis were included in a previous study aiming to develop a practice guideline for early discharge of patients with UGIB. Variables associated with unfavorable evolution were analyzed in order to identify patients with low-risk of re-bleeding. After that, a one-year prospective analysis of all UGIB episodes was carried out. Results: A total of 341 patients were identified in the retrospective study. Variables associated with unfavorable evolution were: systolic blood pressure </= 100 mmHg, heart rate >/= 100 bpm, and a Forrest endoscopic classification of severe. 10% of patients were immediately discharged; however, if predictive variables obtained in the multivariate analysis had been used, hospitalization could have been prevented in 34% of patients. A total of 77 patients were included in the prospective analysis. Although only 19.5% of patients were immediately discharged without complications, 29 patients (37.7%) were theoretically suitable for early discharge. Conclusions: Patients with UGIB who have clean-based ulcers and are stable on admission can be safely discharged immediately after endoscopy. Implementation of the clinical practice guideline safely reduced hospital admission for those patients.
PMID: 20796150 [PubMed - in process]