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Fluids & Electrolytes
FRIDAY, April 2 (HealthDay News) -- Only half of patients in the United Kingdom admitted to the hospital with acute upper gastrointestinal bleeding (AUGIB) receive endoscopy within the first 24 hours, and almost half of all hospitals lack an out-of-hours endoscopy rota even though risk-adjusted mortality rates are lower in hospitals that do have an out-of-hours rota, according to the findings of an audit published online March 31 in Gut.
Sarah A. Hearnshaw, of the Royal Victoria Infirmary in Newcastle upon Tyne, U.K., and colleagues analyzed data on all 6,750 patients aged 16 and above who were admitted to 208 U.K. hospitals over a two-month period in 2007, presenting with AUGIB.
Of the 74 percent of patients who underwent inpatient endoscopy, 50 percent were conducted more than 24 hours after presentation, only 55 percent of high-risk patients were endoscoped within 24 hours and 14 percent of them waited at least 72 hours for the procedure, the researchers found. Twenty-eight percent of patients had lesions at high risk of rebleeding, and only 74 percent of these were given endoscopies. In 52 percent of hospitals, there was a consultant-led out-of-hours endoscopy rota. In these hospitals, compared with those without out-of-hours rota, more first endoscopies were performed out of hours (20 versus 13 percent) and endoscopic therapy was more likely to be administered (25 versus 21 percent). The risk-adjusted mortality ratio was higher in hospitals without a rota (1.21).
"This audit has revealed serious deficiencies in the use of endoscopy for AUGIB in the United Kingdom. While 60 percent of patients with AUGIB present out of hours and almost a fifth of endoscopies are being performed out of hours, in a half of U.K. hospitals contributing to this audit there is no out-of-hours service," the authors write.
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