A team from Cleveland, Ohio, USA assessed the effectiveness of three esophagogastroduodenoscopy (EGD) factors in patients admitted to intensive care units (ICUs) with upper gastrointestinal hemorrhage. These were: (1) accurate initial diagnosis, (2) performance within 24 hours of admission (early EGD), and (3) appropriate intervention.
Records of 214 patients, with upper GI hemorrhage, admitted to the ICU of 10 metropolitan hospitals, were reviewed.
The researchers found that inaccurate diagnosis occurred in 10 per cent of patients at initial EGD. It was associated with significant increases in risk of recurrent bleeding (70 per cent vs. 11 per cent) and rate of surgery (20 per cent vs. 4 per cent). In addition there were significant increases in length of hospital stay (median 7.5 vs. 5 days), length of ICU stay (median 4 vs. 2 days), and rate of readmission to ICU (20 per cent vs. 0.6 per cent). These associations persisted after adjusting for severity of illness.
|Early EGD was associated with reductions in hospital and ICU stays of 33% and 20%, respectively.|
Early EGD - performed in 82 per cent of patients - was associated with significant severity-adjusted reductions in hospital (33 per cent) and ICU (20 per cent) stay.
Appropriate intervention at initial EGD - performed in 84 per cent of patients - was associated with reductions in severity-adjusted length of ICU stay (18 per cent) and rate of recurrent bleeding (odds ratio = 0.37).
Dr Amitabh Chak concluded, "Early, accurate EGD with appropriate therapeutic intervention is effective as practiced in the community, and is associated with improved outcomes for patients with upper GI hemorrhage admitted to the ICU.
"Inaccurate diagnosis at initial EGD is uncommon, but has a significant adverse association with all outcome measures."