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短时间住院治疗方案在治疗非静脉曲张性上消化道出血中的安全性和有效性如何?

Are Short-Stay Units Safe and Effective in the Treatment of Non-Variceal Upper Gastrointestinal Bleeding?

机构信息

Emergency, Anesthesiological and Reanimation Sciencese Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy.

Medical and Abdominal Surgery and Endocrine-Metabolic Scienze, Fondazione Policlinico Universitario A. Gemelli-IRCCS of Rome, 00168 Rome, Italy.

出版信息

Medicina (Kaunas). 2023 May 25;59(6):1021. doi: 10.3390/medicina59061021.

Abstract

: Emergency Department (ED) overcrowding is a health, political, and economic problem of concern worldwide. The causes of overcrowding are an aging population, an increase in chronic diseases, a lack of access to primary care, and a lack of resources in communities. Overcrowding has been associated with an increased risk of mortality. The establishment of a Short Stay Unit (SSU) for conditions that cannot be treated at home but require treatment and hospitalization for up to 72 h may be a solution. SSU can significantly reduce hospital length of stay (LOS) for certain conditions but does not appear to be useful for other diseases. Currently, there are no studies addressing the efficacy of SSU in the treatment of non-variceal upper gastrointestinal bleeding (NVUGIB). Our study aims to evaluate the efficacy of SSU in reducing the need for hospitalization, LOS, hospital readmission, and mortality in patients with NVUGIB compared with admission to the regular ward. : This was a retrospective, single-center observational study. Medical records of patients presenting with NVUGIB to ED between 1 April 2021, and 30 September 2022, were analyzed. We included patients aged >18 years who presented to ED with acute upper gastrointestinal tract blood loss. The test population was divided into two groups: Patients admitted to a normal inpatient ward (control) and patients treated at SSU (intervention). Clinical and medical history data were collected for both groups. The hospital LOS was the primary outcome. Secondary outcomes were time to endoscopy, number of blood units transfused, readmission to the hospital at 30 days, and in-hospital mortality. : The analysis included 120 patients with a mean age of 70 years, 54% of whom were men. Sixty patients were admitted to SSU. Patients admitted to the medical ward had a higher mean age. The Glasgow-Blatchford score, used to assess bleeding risk, mortality, and hospital readmission were similar in the study groups. Multivariate analysis after adjustment for confounders found that the only factor independently associated with shorter LOS was admission to SSU ( < 0.0001). Admission to SSU was also independently and significantly associated with a shorter time to endoscopy ( < 0.001). The only other factor associated with a shorter time to EGDS was creatinine level ( = 0.05), while home treatment with PPI was associated with a longer time to endoscopy. LOS, time to endoscopy, number of patients requiring transfusion, and number of units of blood transfused were significantly lower in patients admitted to SSU than in the control group. : The results of the study show that treatment of NVUGIB in SSU can significantly reduce the time required for endoscopy, the hospital LOS, and the number of transfused blood units without increasing mortality and hospital readmission. Treatment of NVUGIB at SSU may therefore help to reduce ED overcrowding but multicenter randomized controlled trials are needed to confirm these data.

摘要

急诊科(ED)人满为患是一个全球性的健康、政治和经济问题。造成拥挤的原因是人口老龄化、慢性病增加、初级保健服务不足以及社区资源匮乏。人满为患与死亡率增加有关。为那些不能在家治疗但需要治疗和住院治疗不超过 72 小时的疾病设立短期留观病房(SSU)可能是一个解决方案。SSU 可以显著缩短某些疾病的住院时间( LOS ),但对其他疾病似乎没有用处。目前,尚无研究探讨 SSU 在治疗非静脉曲张性上消化道出血(NVUGIB)方面的疗效。我们的研究旨在评估 SSU 在减少 NVUGIB 患者住院、 LOS 、住院再入院和死亡率方面的疗效,与常规病房入院相比。

这是一项回顾性、单中心观察性研究。分析了 2021 年 4 月 1 日至 2022 年 9 月 30 日期间因 NVUGIB 到急诊科就诊的患者的病历。我们纳入了年龄 >18 岁、因急性上消化道出血就诊的患者。受试人群分为两组:入住普通住院病房(对照组)和 SSU 治疗的患者(干预组)。收集了两组的临床和病史数据。住院 LOS 是主要结局。次要结局是内镜检查时间、输血量、30 天内再次住院和院内死亡率。

分析包括 120 名平均年龄 70 岁的患者,其中 54%为男性。60 名患者被收治到 SSU。入住内科病房的患者年龄较大。两组的格拉斯哥-布拉奇福德评分(用于评估出血风险、死亡率和住院再入院)相似。多变量分析发现,在校正混杂因素后,唯一与 LOS 缩短相关的因素是入住 SSU(<0.0001)。入住 SSU 也与内镜检查时间缩短显著相关(<0.001)。唯一与 EGDS 时间缩短相关的其他因素是肌酐水平(=0.05),而在家使用 PPI 治疗与内镜检查时间延长相关。与对照组相比,入住 SSU 的患者的 LOS 、内镜检查时间、需要输血的患者人数和输血量均显著降低。

研究结果表明,SSU 治疗 NVUGIB 可显著缩短内镜检查所需时间、住院时间和输血量,而不增加死亡率和住院再入院率。因此,SSU 治疗 NVUGIB 可能有助于减少急诊科拥挤,但需要多中心随机对照试验来证实这些数据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/103e/10304865/069f50b37e2b/medicina-59-01021-g001.jpg

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