PTU-122 Acute upper gastrointestinal bleeding management: a multi-centre, trainee led audit in north-west england

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Abstract

Background

Despite advances in diagnostics and therapy, acute upper gastrointestinal bleeding (AUGIB) is associated with10%mortality. The National Institute for Health and Care Excellence clinical guideline (NICE ) key priorities for implementation. Using the newly formed Gastroenterology Trainee Research and Improvement Network North West (GasTRIN NoW), we aimed to obtai multi-centre data to audit the management of AUGIB.

Method

A prospective multi-centre AUGIB audit was undertaken across 10 hospitals in North West England between 30/10/2017 26/11/2017. ll patients admitted with suspected UGIB who underwent endoscopy (OGD).tandards were0%100%be offered OGD within 24 hours of admission. Each centre registered the audit locally and anonymised data was pooled within excel for further analysis in R.

Method

Results patients were included across 10 hospitals 83%(n=101) were referred from A+E 17% via primary care. Median age was 65 years (IQR 50–77)66% were male. 50% (n=60) were admitted during weekdays between 07:00 and 19:00. At admission, 46%(n=56) had either a Glasgow Blatchford orpre-ockall score. 32 patients were on anti-platelet, 21 on anticoagulants (warfarin, DOAC or LMWH) and 16 on NSAIDs (13%), 64% (n=70) received either oral or IV PPI prior to OGD.

Method

Fiftyfour percent of those with varices required banding or glue therapy (n=7/13) while 12% (n=13/108) required therapy for non-variceal bleeding. Haemostasis was achieved in 90%(n=18). Length of stay in these patients were longer compared to those not requiring therapy (median 6 days (IQR: 5–7) vs. 4 days (IQR:2–7); p=0.04). There were 7 deaths at 30 day follow up only 1 directly attributable to AUGIB.

Conclusion

NICE standards comparable to data presented by The GARnet Improvements are needed to deliver NICE standards

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