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The importance of process issues as predictors of time to endoscopy in patients with acute upper-GI bleeding using the RUGBE data

  • Eduardo B. da Silveira
    Affiliations
    Current affiliations: Divisions of Gastroenterology (Dr da Silveira, Ms Martel, Dr Barkun), Epidemiology and Biostatistics (Drs da Silveira, Barkun), and the Department of Internal Medicine (Drs Bensoussan and Barkun), the McGill University Health Centre, McGill University, Montréal, Québec, and the Division of Gastroenterology (Dr Lam), St-Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. A complete list of the members of the RUGBE Group is given at the end of this article
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  • Eric Lam
    Affiliations
    Current affiliations: Divisions of Gastroenterology (Dr da Silveira, Ms Martel, Dr Barkun), Epidemiology and Biostatistics (Drs da Silveira, Barkun), and the Department of Internal Medicine (Drs Bensoussan and Barkun), the McGill University Health Centre, McGill University, Montréal, Québec, and the Division of Gastroenterology (Dr Lam), St-Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. A complete list of the members of the RUGBE Group is given at the end of this article
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  • Myriam Martel
    Affiliations
    Current affiliations: Divisions of Gastroenterology (Dr da Silveira, Ms Martel, Dr Barkun), Epidemiology and Biostatistics (Drs da Silveira, Barkun), and the Department of Internal Medicine (Drs Bensoussan and Barkun), the McGill University Health Centre, McGill University, Montréal, Québec, and the Division of Gastroenterology (Dr Lam), St-Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. A complete list of the members of the RUGBE Group is given at the end of this article
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  • Karen Bensoussan
    Affiliations
    Current affiliations: Divisions of Gastroenterology (Dr da Silveira, Ms Martel, Dr Barkun), Epidemiology and Biostatistics (Drs da Silveira, Barkun), and the Department of Internal Medicine (Drs Bensoussan and Barkun), the McGill University Health Centre, McGill University, Montréal, Québec, and the Division of Gastroenterology (Dr Lam), St-Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. A complete list of the members of the RUGBE Group is given at the end of this article
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  • Alan N. Barkun
    Correspondence
    Reprint requests: Alan N. Barkun, MD, Division of Gastroenterology, McGill University Health Centre, Room D7.148, 1650 Cedar Ave, Montréal, Québec, CANADA H3G 1A4.
    Affiliations
    Current affiliations: Divisions of Gastroenterology (Dr da Silveira, Ms Martel, Dr Barkun), Epidemiology and Biostatistics (Drs da Silveira, Barkun), and the Department of Internal Medicine (Drs Bensoussan and Barkun), the McGill University Health Centre, McGill University, Montréal, Québec, and the Division of Gastroenterology (Dr Lam), St-Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. A complete list of the members of the RUGBE Group is given at the end of this article
    Search for articles by this author
  • for the RUGBE investigators

      Background

      Early endoscopy has been shown to improve outcomes and optimize cost-effectiveness in nonvariceal upper-GI bleeding (NVUGIB). However, there is little information regarding clinical and process determinants that affect the time from onset of bleeding to performance of the endoscopy.

      Objective

      The aim of this study was to identify factors that predict time to endoscopy in patients with new onset NVUGIB.

      Design

      Linear regression models were constructed with time between triage (outpatients) or onset of bleeding (inpatients) and the performance of endoscopy.

      Setting

      The RUGBE is a nationwide, multicenter database collected for the purpose of obtaining descriptive data on patients with NVUGIB.

      Patients

      The study population consisted of 1500 patients (89.6%) who underwent gastroscopy within 48 hours.

      Results

      Median time to endoscopy was 12 hours (95% CI 11.0, 13.0). Endoscopy after working hours (regression coefficient [β] −3.52; 95% CI −5.47, −1.58), availability of an endoscopy nurse on-call for the procedure (β −2.48; 95% CI −3.83, −1.14), and admission to a hospital unit were associated with a shorter interval to endoscopy. In contrast, the presence of chest pain (β 3.65; 95% CI 1.64, 5.67) or dyspnea (β 2.79; 95% CI 1.10, 4.48), absence of gross blood on rectal examination (β 2.20; 95% CI 0.69, 3.71), and inpatient status at onset of bleeding (β 14.6; 95% CI 8.70, 20.4) were independent predictors of a delayed endoscopy. Subgroup analysis showed that actual time intervals as well as independent predictors of time until endoscopy differed between inpatients and outpatients.

      Limitations

      Retrospective analysis.

      Conclusions

      The timing of endoscopy in patients with NVUGIB is dependent on both clinical and process parameters, which differ between inpatient and outpatient settings. They bear implications with regards to shaping practice and deciding on resource allocation in order to facilitate an early endoscopy, which is currently recommended for improved patient outcomes.
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