Prospective evaluation of a clinical guideline recommending early patients discharge in bleeding peptic ulcer

• Published in: Journal of gastroenterology and hepatology 2010-09, Vol.25 (9), p.1525-1529
• Main Authors: Chaparro, María, Barbero, Almudena, Martín, Leticia, Esteban, Carlos, Espinosa, Laura, De La Morena, Felipe, Sánchez, Argeme, Martín, Irene, Santander, Cecilio, Moreno-Otero, Ricardo, Gisbert, Javier P
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; bleeding; Chi-Square Distribution; duodenal; Endoscopy, Gastrointestinal; Female; gastric; Gastroenterology. Liver. Pancreas. Abdomen; gastrointestinal; guideline; Guideline Adherence - statistics & numerical data; Hematemesis - etiology; Hematemesis - therapy; hospitalization; Humans; Length of Stay - statistics & numerical data; Male; Medical sciences; Melena - etiology; Melena - therapy; Middle Aged; Other diseases. Semiology; Patient Discharge - statistics & numerical data; Patient Selection; Peptic Ulcer Hemorrhage - complications; Peptic Ulcer Hemorrhage - diagnosis; Peptic Ulcer Hemorrhage - therapy; Practice Guidelines as Topic; prognosis; Prospective Studies; Quality of Health Care - statistics & numerical data; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Spain; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Treatment Outcome; ulcer
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/j.1440-1746.2010.06374.x

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.