Does gastroenterology consultation change management of patients receiving hematopoietic stem cell transplantation?
Gastrointestinal complications following hematopoietic stem cell transplantations (HSCTs) are common, but it is unknown how often gastroenterology consultation (GEC) early post BMT leads to specific changes in patient management. We aimed to determine the reason(s) for GEC, the diagnoses found through GEC, whether the advice or intervention led to change(s) in management and if intervention led to any adverse outcome within the first 100 days post HSCT. We undertook a retrospective review of all patients at least 18 years old (n = 197) who underwent HSCT between November 1990 and April 1998. Of these, 79 patients had 92 consultations for a total of 163 separate GE problems within the first 100 days post HSCT. Data were obtained through chart review. It was determined whether the intervention or advice given by the consultant led to actual changes in patient management or outcome. We found that the characteristics more likely to be associated with GEC included female patient vs male (P = 0.03), allogeneic vs autologous transplants (P < 0.001), hematologic vs solid malignancies (P = 0.006), and leukemias vs lymphomas (P = 0.013). Overall, a definitive diagnosis for an identified complaint was made in 71% (range 25-87%). A change in management was effected in 54% of cases (range 0-59%). Endoscopy led to perforation and subsequent death in two patients (1.8%). Gastrointestinal disease was a direct cause of death in 2.5% of all patients. In conclusion, a definite diagnosis was reached in 71% of gastrointestinal problems and management was effected in 54% of cases. Since endoscopy was associated with a mortality of 1.8%, minimizing its use for the cases in which no impact is made, should be considered.
Fallows
G
G
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Rubinger
M
M
Bernstein
C N
CN
D000328:Adult; D000368:Aged; D002423:Cause of Death; D019468:Disease Management; D016145:Endoscopy, Digestive System / Q000401:mortality; D005260:Female; D005762:Gastroenterology; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000209:etiology; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D012017:Referral and Consultation; D012189:Retrospective Studies