https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(00)02816-6.pdf

A risk score to predict need for treatment for upper-gastrointestinal haemorrhage.

Context. —Upper gastrointestinal tract hemorrhage (UGIH) is a common and potentially life-threatening disorder. Resource utilization can vary without adverse effect on patient outcome. Clinical practice guidelines are a potential solution to reduce variation in practice while improving patient outcomes. Objective. —To validate prospectively the safety, acceptability, and impact of a clinical practice guideline defining the medically appropriate length of stay (LOS) for patients hospitalized with UGIH. Design. —Prospective, controlled time-series study with an alternate-month design. Outcome surveyors and patients were blinded to study group allocation. Guideline. —A retrospectively validated scoring system using 4 independent variables: hemodynamics, time from bleeding, comorbidity, and esophagogastroduodenoscopy (EGD) findings to predict risk of adverse events. The quantitative risk for the low-risk subset was 0.6% (95% confidence interval [CI], 0.0%-2.0%) for subsequent complications and 0% (95% CI, 0.0%-0.9%) for life-threatening complications from this retrospective evaluation. Setting. —A 1000-bed, not-for-profit, university-affiliated teaching hospital. Patioents. —Consecutive adult patients hospitalized for acute UGIH. Intervention. —Concurrent feedback of guideline recommendation (same-day hospital discharge) to physicians caring for patients at low risk for complication. No risk information was provided during control months. Results. —Seventy percent (209/299) of UGIH patients achieved low-risk status according to the guideline and were therefore potentially suitable for early discharge from the hospital. Providing real-time quantitative risk information (intervention group only) was associated with an increase in guideline compliance from 30% to 70% (P Conclusions. —Implementation of the clinical practice guideline safely reduced hospital LOS for selected low-risk patients with acute UGIH. Further prospective validation in other settings is warranted.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=419528&pdfFileName=jama_278_24_031.pdf

Prospective Evaluation of a Clinical Guideline Recommending Hospital Length of Stay in Upper Gastrointestinal Tract Hemorrhage

https://www.giejournal.org/article/S0016-5107(95)70191-5/pdf

Prospective validation of the Baylor bleeding score for predicting the likelihood of rebleeding after endoscopic hemostasis of peptic ulcers

Depression increases mortality and morbidity in acute life-threatening medical illness

https://www.emed.theclinics.com/article/S0733-8627(05)70055-9/pdf

Evaluation of the patient with gastrointestinal bleeding: an evidence based approach.

The widely differing mortality rates of severe gastroduodenal hemorrhage reported in the literature (10-30%), are due to very inhomogeneous patient groups The purpose of this study was therefore to rank various clinical and endoscopical factors by giving them points from 0 to 6, both to establish comparable groups and to use them as prognostic parameters for a potential fatality rate One hundred and ninety-three patients with severe gastroduodenal bleeding, verified at emergency gastroscopy immediately after admission, were admitted to this prospective study The statistical assessment of the prognosis for these 8 factors revealed a linear correlation between increasing score and mortality rate for the following risk factors: patient age, activity and intensity of hemorrhage, type and number of associated illnesses, various therapeutic procedures Only the type of the source and the site of the hemorrhage did not correlate well By adding up the points of all risk factors for every patient we calculated the overall score and established a correlation to the mortality rate: A definite statistical correlation was demonstrated between increasing score and fatal outcome If a patient with a score of less than 20 points did survive in 100%, the mortality rate increased linearly to 833% in patients with a score of 40 points Using this scoring system it is possible to establish comparable groups of patients - which seems indispensable for a critical examination of various therapeutic procedures Furthermore, this score can serve as a predictor of the probability of a fatal outcome shortly after patient admission

Estimation of the mortality rate of patients with severe gastroduodenal hemorrhage with the aid of a new scoring system.

Intraoperative manometry was performed in 771 patients undergoing cholecystectomy with (n = 158) and without (n = 613) interventions on the common bile duct and papilla. The method measures the restin

Intraoperative Manometry – A Useful Tool in Biliary Surgery?

Over a 5-year period, 443 patients were treated for primary gallstone disease. There were 333 patients with negative preoperative findings in the common bile ducts (CBD) on sonography and liver enzymes estimation who underwent cholecystectomy without endoscopic retrograde cholangiography (ERC). Thirty-eight surgical explorations of the choledochus were necessary, and in 11 patients a second intervention (endoscopically) had to be performed. There were 110 patients with signs of stone formation in the bile ducts. These patients were submitted to examination of the CBD by ERC. Choledocholithiasis was found in 67 patients; in 47, endoscopic papillotomy and stone extraction were successful. On 7 occasions it was insufficient and in 13 patients it was not attempted due to the size of the stone. One second intervention (endoscopically) had to be performed in this group of patients. The sonographical and laboratory suspicion of bile ductstones could be disproved in 43 patients. In these cases, the preoperative ERC was negative. We therefore had information on the bile duct system preoperatively and no surgical bile duct exploration was necessary for diagnosis. Thirty-eight of 333 patients (11.4%) had a false-negative and 43 of 110 (39%) a false-positive sonographical or laboratory diagnosis. This shows that there is no other preoperative diagnostic test other than ERC for the precise preoperative evaluation of common bile duct stones. Morbidity, mortality and the rate of choledochus revision (especially negative explorations) can be reduced by preoperative endoscopic bile duct stone removal. In cases where bile duct stones are suspected, we recommend endoscopic retrograde cholangiography for clarification and, if stones are verified, endoscopic papillotomy and stone extraction followed by simple cholecystectomy for therapy, thus avoiding surgical bile duct explorations.

Combined endoscopic and surgical approach to primary gallstone disease.

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Estimation of the mortality rate of patients with severe gastroduodenal hemorrhage with the aid of a new scoring system.

Intraoperative Manometry – A Useful Tool in Biliary Surgery?

Combined endoscopic and surgical approach to primary gallstone disease.

Foreword by the Editors