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84 PREDICTORS OF TIME TO ENDOSCOPY IN ACUTE NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING USING THE RUGBE DATA EB da Silveira, AN Barkun, E Lam, L Joseph, M Martel, K Bensoussan
INTRODUCTION: Early endoscopy has been shown to improve outcomes and optimize cost effectiveness when managing patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). However, little information is known about factors which may affect the time from onset of bleeding until performance of the endoscopy.
AIM: To determine variables which predict time to endoscopy in patients with new onset NVUGIB.
METHODS: The Canadian Registry of patients with upper gastrointestinal bleeding undergoing endoscopy (RUGBE) is a multicentre database collected for the purpose of obtaining descriptive data on patients with NVUGIB in Canada. RUGBE includes 217 variables on 1869 patients collected between 1999 and 2002, and methods have been validated and detailed in full publications previously. Linear regression models were used with time between admission (outpatients) or onset of bleeding (inpatients) and performance of endoscopy as the dependent variable. Selected variables relating to patients' characteristics before endoscopy were assessed as independent predictors.
RESULTS: The study population consisted of 1675 patients (89.6%) who underwent gastroscopy within 48 h. Endoscopy after working hours (6 PM to 8 AM) [CI -5.62 to -1.65], availability of nurse on-call for the procedure [CI -3.84 to -1.16], worsening in health status (ASA score) [CI -1.77 to -0.33] and admission to ICU [CI -5.12 to -1.67] were associated with a shorter interval to endoscopy. Increasing age [CI 0.005 to 0.077)], presence of chest pain (CP) [CI 1.63 to 5.72] or dyspnea [CI 1.42 to 4.84], absence of gross blood on rectal examination [CI 1.20 to 4.23] and inpatient status [CI 4.31 to 7.45] were independent predictors of delayed endoscopy. A subgroup analysis showed that health status, presence of CP and findings on rectal were independent predictors in hospitalized patients. In contrast, time of the day of the endoscopy, availability of on-call nurse, age, admission to ICU, dyspnea, chest pain and absence of gross blood on rectal exam were independent predictors for outpatients.
CONCLUSIONS: These predictive models suggest that the timing of endoscopy in patients with NVUGIB is dependent on both clinical and administrative parameters, which differ between in- and outpatient settings. They bear implications with regards to shaping practice and deciding on resource allocation in order to facilitate an early endoscopy as is currently recommended to improve patient outcomes.