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J Korean Soc Emerg Med > Volume 32(5); 2021 > Article
Journal of The Korean Society of Emergency Medicine 2021;32(5): 386-393.
응급실에 내원한 상부위장관 정맥류 출혈 환자에서 표준진료지침의 적용이 환자의 예후 및 응급실 체류시간에 미치는 영향
이재환1 , 유제성1 , 박고은2 , 박주영2 , 정성필1 , 공태영1 , 범진호1 , 고동률1
1연세대학교 의과대학 응급의학교실
2연세대학교 의과대학 연구부 통계지원팀
Usefulness of critical pathway for variceal upper gastrointestinal bleeding in the emergency department for the treatment and prognosis of patients
Jaehwan Lee1 , Je Sung You1 , Go Eun Park2 , Ju-young Park2 , Sung Phil Chung1 , Tae Young Kong1 , Jin Ho Beom1 , Dong Ryul Ko1
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Dong Ryul Ko ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: kkdry@yuhs.ac,
Received: June 25, 2020; Revised: September 9, 2020   Accepted: September 25, 2020.  Published online: October 31, 2021.
ABSTRACT
Objective:
Endoscopic hemostasis is a key treatment for variceal upper gastrointestinal bleeding. However, the effects of early endoscopy in variceal upper gastrointestinal bleeding have not been sufficiently studied. This study investigated the effects of the use of the critical pathway (CP) for upper gastrointestinal bleeding.
Method:
The study was designed as a ‘before and after’ study. A group of patients diagnosed with variceal upper gastrointestinal bleeding from January 1, 2011, to December 31, 2014, and CP activated patients from January 1, 2015, to December 31, 2018, were reviewed retrospectively. The study endpoints included an analysis of the following in the two groups: time from emergency department (ED) arrival to endoscopy, number of blood transfusions, hospitalization period, intensive care unit (ICU) admission, 30-day mortality.
Results:
From January 1, 2011, to December 31, 2018, 207 patients were admitted with variceal upper gastrointestinal bleeding, and 137 patients with a Blatchford score of 7 or higher were included in the study. Of these, 88 patients visited before the implementation of CP and 49 patients visited thereafter. The time from ED arrival to endoscopy was 218.1±201.7 minutes in the CP activated group, which was about 200 minutes shorter (P=0.046) than the non-CP group. There was no statistical difference in 30-day mortality, transfusion, emergency room hospitalization time, number of ICU admissions, and hospitalization days (P=0.348, P=0.394, P=0.651, P=0.164, and P=0.069).
Conclusion:
After CP, the time to endoscopy was significantly shortened, but it did not reduce mortality.
Key words: Gastrointestinal hemorrhage; Esophageal varices; Gastric varices; Endoscopy; Hemostasis; Critical pathways
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