BACKGROUND: Urgent endoscopy in patients with acute upper-GI bleeding identifies many patients who may be safely treated without hospitalization. The aim of this multicenter trial was to determine whether urgent endoscopy effectively decreases health care resource utilization in a real-life setting where primary care providers determine the course of care. METHODS:Ninety-three outpatients with acute upper-GI bleeding were randomized to either urgent endoscopy (before hospitalization) or elective endoscopy after admission. The results of urgent endoscopy and a recommendation regarding patient disposition were provided to the attending physician. Medical outcomes and resource utilization were measured. RESULTS: The timing of endoscopy did not affect resource utilization or patient outcomes. Length of stay was similar (urgent endoscopy, OR 3.98 days: 95% CI[2.84, 5.11] vs. elective endoscopy, OR 3.26 days: 95% CI[2.32, 4.21], p=0.45). The mean number of days in an intensive care unit was the same (1.2 days). The urgent endoscopy group had more high-risk endoscopic lesions (15 vs. 9; p=0.031). Outpatient care was recommended for 19 patients (40%). Only 4 patients were discharged. CONCLUSIONS: Urgent endoscopy did not reduce hospitalization or resource utilization because the results of early endoscopy did not impact the decision by attending physicians regarding admission. For early (triage) endoscopy to impact resource utilization, the results of endoscopy must change subsequent patient care.
RCT Entities:
BACKGROUND: Urgent endoscopy in patients with acute upper-GI bleeding identifies many patients who may be safely treated without hospitalization. The aim of this multicenter trial was to determine whether urgent endoscopy effectively decreases health care resource utilization in a real-life setting where primary care providers determine the course of care. METHODS: Ninety-three outpatients with acute upper-GI bleeding were randomized to either urgent endoscopy (before hospitalization) or elective endoscopy after admission. The results of urgent endoscopy and a recommendation regarding patient disposition were provided to the attending physician. Medical outcomes and resource utilization were measured. RESULTS: The timing of endoscopy did not affect resource utilization or patient outcomes. Length of stay was similar (urgent endoscopy, OR 3.98 days: 95% CI[2.84, 5.11] vs. elective endoscopy, OR 3.26 days: 95% CI[2.32, 4.21], p=0.45). The mean number of days in an intensive care unit was the same (1.2 days). The urgent endoscopy group had more high-risk endoscopic lesions (15 vs. 9; p=0.031). Outpatient care was recommended for 19 patients (40%). Only 4 patients were discharged. CONCLUSIONS: Urgent endoscopy did not reduce hospitalization or resource utilization because the results of early endoscopy did not impact the decision by attending physicians regarding admission. For early (triage) endoscopy to impact resource utilization, the results of endoscopy must change subsequent patient care.
Authors: Keith Siau; James Hodson; Richard Ingram; Andrew Baxter; Monika M Widlak; Caroline Sharratt; Graham M Baker; Tom Troth; Ben Hicken; Faraz Tahir; Malik Magrabi; Nouman Yousaf; Claire Grant; Dennis Poon; Hesham Khalil; Hui Lin Lee; Jonathan R White; Huey Tan; Syazeddy Samani; Patricia Hooper; Saeed Ahmed; Muhammad Amin; Sara Mahgoub; Khayal Asghar; Farique Leet; Matthew J Harborne; Beata Polewiczowska; Sheeba Khan; Muhammad R Anjum; Michael McFarlane; Ella Mozdiak; Lauren D O'Flynn; Ilona C Blee; Rachel M Molyneux; Ashok Kurian; Syed N Abbas; Abdullah Abbasi; Aadil Karim; Asif Yasin; Fawad Khattak; Josephine White; Ruhina Ahmed; James A Morgan; Lance Alleyne; Mohamed A Alam; Naaventhan Palaniyappan; Victoria J Rodger; Paramvir Sawhney; Nasar Aslam; Theodore Okeke; Adam Lawson; Danny Cheung; Jeremy P Reid; Ashish Awasthi; Mark R Anderson; Joe R Timothy; Sanjeev Pattni; Saqib Ahmad; Gillian Townson; Jeremy Shearman; Vanja Giljaca; Matthew J Brookes; Ben R Disney; Neil Guha; Titus Thomas; Anthony Norman; Peter Wurm; Ashit Shah; Neil C Fisher; Sauid Ishaq; Giles Major Journal: United European Gastroenterol J Date: 2018-10-28 Impact factor: 4.623