Lower GI bleed audit

Abstract

Abstract Introduction In the UK, Lower GI Bleeding is common emergency presentation and accounts for 3% of emergency surgical referrals. The most common cause is Diverticular Bleeds. Other frequent causes are the benign anorectal conditions. 23% of patients admitted to Hospital with LGIB in the UK are discharged without diagnosis. Most LGIB resolves on its own but may require further interventions. Aim To describe current local practice of risk stratification with Shock Index and Oakland’s Score in comparison with existing national guidelines by the British Society of Gastroenterology (BSG). Method Retrospective Analysis of 36 patients who presented to the local A&E with lower GI bleed between Sept 2021 – Nov 2021. Result Male:Female 18:18. Median age 56 years (3months – 95years). Haemorrhoids (9, 25%) accounted for most of the presentation. 1 patient (3%) had their shock index documented. 2 patients (6%) needed a CT angiogram. 16 patients (44%) were admitted under the EGS team. Out of these 16 patients, 7 (44%) needed inpatient endoscopy, while 3 (19%) required transfusion. Discussion There was a consistent finding of no documented shock index in the patients notes, likely because there is easy access to EWS that allow clinicians to interpret this in real time. The Oakland score was rarely used to determine if a patient could safely be discharged. Other specialties, endoscopy/gastroenterology or the emergency department, likely have different guidelines for the assessment of lower GI bleed. This could account for poor uptake, locally, of risk stratification as proposed by the BSG.