T1069 Appropriateness for Ordinary Hospital Admission of Patients With Nonvariceal Upper Gastrointestinal Haemorrhage

Abstract

GIB was matched in 77.2% (3057/3960) of cases. Mean age was 58.5y (range 12-103y) and 66.5% were males. Upper GIB (UGIB) accounted for 1911 (66.7%) cases. The top 3 causes were: 1. Peptic ulcer disease (54.1%), 2. Gastroduodenitis (16.3%) and 3. Mallory Weiss Tear (13.4%). Variceal UGIB (VUGIB) accounted for 7.5% of UGIB events. The proportion of UGIB fell from 69.4% in 2004 to 67.0% in 2008 (p=0.038,R2=0.96). Mortality rates for non-VUGIB fell from 2.5% to 2.1% (p=0.356,R2=0.28) while VUGIB mortality rates fell from 14.9% to 9.0% (p=0.356,R2=0.28). Endoscopic hemostasis rates rose from 97.6% to 99.0% (p=0.093,R2=0.67). Angiotherapy rate was 0.9% with no change over the 5 years. Significant risk factors for mortality among UGIB were: age (odds ratio (OR):1.04; 95% confidence interval (CI):1.02-1.06), number of comorbidities (OR:1.59; 95% CI:1.32-1.90) and ICU admission (OR:17.0; 95% CI:6.5-44.4). Lower GIB (LGIB) accounted for 954 (33.3%) cases. The top 3 causes were: 1. Piles (39.6%), 2. Diverticular disease (29.8%) and 3. Colorectal cancer (14.0%). The proportion of LGIB cases rose from 30.6% in 2004 to 33.0% in 2008 (p=0.032,R2=0.83) and this was contributed by a rise in ischemic colitis cases from 1.2% to 5.9% (p=0.024,R2=0.98). Mortality rate for LGIB was 2.3% with no significant change over the 5 years. Therapeutic colonoscopy rates dropped from 15.2% to 10.3% (p=0.043,R2=0.96) while angiotherapy rates rose from 1.8% to 4.9% (p=0.278,R2= 0.37). Surgical rate was 4.7% without significant change over the 5 years. Significant risk factors for mortality among LGIB were: age (OR:1.07; 95% CI:1.03-1.12), number of comorbidities (OR:1.52, 95% CI:1.14-2.03) and surgery (OR:4.51; 95% CI:1.20-17.0). Conclusions: ED admission diagnosis of acute GIB was correctly matched by in-patient discharge diagnosis in 77.2% of cases. Trend of UGIB was falling with reduction in mortality and surgical rates. There was a rising trend in LGIB, contributed by a rise in ischemic colitis events over the same period. Mortality and surgical rates remained unchanged for LGIB while colonoscopic intervention rates fell and angiotherapy rates rose.