The Impact of Night-time Emergency Department Presentation on Upper Gastrointestinal Hemorrhage Outcomes

被引:2
作者
Alayo, Quazim A. [1 ,2 ]
Oyenuga, Abayomi O. [3 ]
Adejumo, Adeyinka C. [4 ]
Pottathil, Vijay [5 ]
Grewal, Damanpreet [5 ]
Okafor, Philip N. [5 ]
机构
[1] St Lukes Hosp, Dept Internal Med, Chesterfield, England
[2] Washington Univ, Div Gastroenterol, John T Milliken Dept Med, Sch Med St Louis, St Louis, MO USA
[3] Univ Minnesota, Dept Med, Box 736 UMHC, Minneapolis, MN 55455 USA
[4] Univ Pittsburgh, Div Gastroenterol Hepatol & Nutr, Dept Med, Pittsburgh, PA USA
[5] Stanford Univ, Div Gastroenterol & Hepatol, Sch Med, Stanford, CA USA
关键词
upper gastrointestinal bleeding; night-time; emergency room; UPPER GI HEMORRHAGE; VARICEAL HEMORRHAGE; PORTAL-HYPERTENSION; WEEKDAY ADMISSION; WEEKEND; MORTALITY; PERFORMANCE; PROGNOSIS; ERRORS;
D O I
10.1097/MCG.0000000000001596
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Goals: The aim was to investigate the impact of night-time emergency department (ED) presentation on outcomes of patients admitted for acute upper gastrointestinal hemorrhage (UGIH). Background: The relationship between time of ED presentation and outcomes of gastrointestinal hemorrhage is unclear. Study: Using the 2016 and 2017 Florida State Inpatient Databases which provide times of ED arrival, we identified and categorized adults hospitalized for UGIH to daytime (07:00 to 18:59 h) and night-time (19:00 to 06:59 h) based on the time of ED presentation. We matched both groups with propensity scores, and assessed their clinical outcomes including all-cause in-hospital mortality, in-hospital endoscopy utilization, length of stay (LOS), total hospitalization costs, and 30-day all-cause readmission rates. Results: Of the identified 38,114 patients with UGIH, 89.4% (n= 34,068) had acute nonvariceal hemorrhage (ANVH), while 10.6% (n= 4046) had acute variceal hemorrhage (AVH). Compared with daytime patients, ANVH patients admitted at night-time had higher odds of in-hospital mortality (odds ratio: 1.32; 95% confidence interval: 1.06-1.60), lower odds of in-patient endoscopy (odds ratio: 0.83; 95% confidence interval: 0.77-0.90), higher total hospital costs ($9911 vs. $9545, P< 0.016), but similar LOS and readmission rates. Night-time AVH patients had a shorter LOS (5.4 vs. 5.8 d, P= 0.045) but similar mortality rates, endoscopic utilization, total hospitalization costs, and readmission rates as daytime patients. Conclusions: Patients arriving in the ED at night-time with ANVH had worse outcomes (mortality, hospitalization costs, and endoscopy utilization) compared with daytime patients. However, those with AVH had comparable outcomes irrespective of ED arrival time.
引用
收藏
页码:576 / 583
页数:8
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