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Admission time is associated with outcome of upper gastrointestinal bleeding: results of a multicentre prospective cohort study
Author(s) -
Groot N. L.,
Bosman J. H.,
Siersema P. D.,
Oijen M. G. H.,
Bredenoord A. J.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2012.05205.x
Subject(s) - medicine , weekend effect , evening , prospective cohort study , odds ratio , adverse effect , upper gastrointestinal bleeding , logistic regression , emergency department , emergency medicine , pediatrics , endoscopy , physics , astronomy , psychiatry
Summary Background It has been suggested that patients presenting with upper gastrointestinal bleeding ( UGIB ) during the weekend have a worse outcome compared with weekdays, with an increased risk of recurrent bleeding and mortality. Aim To investigate the association between timing of admission and adverse outcome after UGIB . Methods We prospectively collected data from patients presenting with symptoms suggestive of UGIB to the emergency room of eight participating hospitals. Using standard descriptive statistics and logistic regression analyses, differences in 30‐day mortality, rebleeding rate, and need for angiography and surgical intervention were assessed for week‐ and weekend admissions and time of admission. Moreover, patient‐ and procedure‐related factors were identified that could influence outcome. Results In total, 571 patients were included with suspected UGIB . Patient admitted during the weekend had a higher mortality rate than patients admitted during the week [9% vs.3%; adjusted odds ratio 2.68 (95% CI 1.07–6.72)]. Weekend admissions were not associated with other adverse outcomes. Patients admitted during the weekend presented more often with bleeding and had a significantly lower systolic and diastolic blood pressure. No differences were found in procedure‐related factors. Time of admission was not associated with an adverse outcome, although patients admitted during the evening had a significantly longer time to endoscopy (15, 22 and 16 h for day, evening and night admissions respectively, P < 0.01). Conclusion Although quality of care did not appear to differ between week/weekend admissions, patients with suspected upper gastrointestinal bleeding admitted during the weekend were at higher risk of an adverse outcome. This might be due to the fact that these patients have more severe haemorrhage.