University of Adelaide, Adelaide, South Australia, Australia.
Intern Med J. 2013 Jul;43(7):803-9. doi: 10.1111/imj.12042.
Acute severe colitis (ASC) is a serious condition with possible outcomes of emergency colectomy and mortality. Validated guidelines exist to help avoid these.
To examine local adherence to guidelines and identify (a) opportunities to improve care and (b) possible barriers to adherence.
Retrospective, hospital-wide audit of all patients with ASC during a 2-year period (2009-2010) at a major metropolitan hospital. Cases were identified by an electronic search of all discharges with International Classification of Diseases-10 codes for colitis, colectomy, ulcerative colitis or Crohn disease.
Twenty-six patients had 30 ASC admissions (14 female). Most admissions were under gastroenterology (25), 4 (13%) were under general medicine and 1 was under general surgery. Only 8 patients' (26%) management (all under gastroenterology) included all major details: blood investigations, Clostridium difficile test, abdominal X-ray, colonic examination and venous thromboembolism prophylaxis. Only one patient had formal severity scoring on admission, and seven patients (24%) had descriptive severity recorded. On day 3, nine patients (30%) had some recorded severity assessment; however, no formal criteria were used. Four had colectomy, three during first admission and one on re-admission. Of these patients, three received cyclosporine prior to colectomy. The mean duration of admission was 10 days (standard deviation 10.54, range 1-61).
Opportunities to optimise care exist including formal severity assessments on days 1 and 3, better deep vein thrombosis/pulmonary embolism prophylaxis and prompt colonic examination. Admission under teams other than gastroenterology appeared to be a barrier to better care. Despite the low rate of ideal management, the colectomy rate was acceptably low at 20%.
急性重度结肠炎（ASC）是一种严重的疾病，可能需要紧急结肠切除术和死亡。现已有验证有效的指南来帮助避免这些情况。
检查当地对指南的遵守情况，并确定（a）改善护理的机会和（b）可能存在的遵守障碍。
对一家主要大都市医院在 2 年期间（2009-2010 年）所有 ASC 患者进行回顾性、全院范围的审核。通过对所有以结肠炎、结肠切除术、溃疡性结肠炎或克罗恩病的国际疾病分类第 10 版代码为索引的出院记录进行电子搜索来识别病例。
26 例患者有 30 例 ASC 入院（14 例女性）。大多数入院治疗是在胃肠病学（25 例），4 例（13%）是在普通内科，1 例是在普通外科。只有 8 例（26%）患者的（全部在胃肠病学下）管理包括所有主要细节：血液检查、艰难梭菌检测、腹部 X 射线、结肠检查和静脉血栓栓塞预防。只有 1 例患者在入院时进行了正式的严重程度评分，7 例（24%）记录了描述性严重程度。在第 3 天，9 例（30%）患者有一些记录的严重程度评估；但是，没有使用正式标准。有 4 例行结肠切除术，其中 3 例在首次入院时进行，1 例在再次入院时进行。这些患者中，有 3 例在结肠切除术前接受了环孢素治疗。住院平均时间为 10 天（标准差为 10.54，范围为 1-61）。
存在优化护理的机会，包括在第 1 天和第 3 天进行正式的严重程度评估、更好的深静脉血栓形成/肺栓塞预防以及及时进行结肠检查。在胃肠病学以外的团队下入院似乎是更好护理的障碍。尽管理想管理的比率较低，但结肠切除术的比率为 20%，这是可以接受的。
