응급실에 내원한 상부위장관 정맥류 출혈 환자에서 표준진료지침의 적용이 환자의 예후 및 응급실 체류시간에 미치는 영향 (Usefulness of critical pathway for variceal upper gastrointestinal bleeding in the emergency department for the treatment and prognosis of patients)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 32권 / 5호 / 386 ~ 393페이지
· 저자명 : 이재환, 유제성, 박고은, 박주영, 정성필, 공태영, 범진호, 고동률

초록

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.
Methods: 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.

영어초록

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.
Methods: 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.

참고자료

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