title: Prospective evaluation of a clinical guideline recommending early patients discharge in bleeding peptic ulcer.
abstract: OBJECTIVE
  To validate an early discharge policy in patients admitted with upper gastrointestinal bleeding (UGIB) due to ulcers.
  
  
  METHODS
  Patients with gastroduodenal ulcer or erosive gastritis/duodenitis were included in a previous study aiming to develop a practice guideline for early discharge of patients with UGIB. Variables associated with unfavorable evolution were analyzed in order to identify patients with low-risk of re-bleeding. After that, a one-year prospective analysis of all UGIB episodes was carried out.
  
  
  RESULTS
  A total of 341 patients were identified in the retrospective study. Variables associated with unfavorable evolution were: systolic blood pressure < or = 100 mmHg, heart rate > or = 100 bpm, and a Forrest endoscopic classification of severe. 10% of patients were immediately discharged; however, if predictive variables obtained in the multivariate analysis had been used, hospitalization could have been prevented in 34% of patients. A total of 77 patients were included in the prospective analysis. Although only 19.5% of patients were immediately discharged without complications, 29 patients (37.7%) were theoretically suitable for early discharge.
  
  
  CONCLUSIONS
  Patients with UGIB who have clean-based ulcers and are stable on admission can be safely discharged immediately after endoscopy. Implementation of the clinical practice guideline safely reduced hospital admission for those patients.
authors.affiliation: Gastroenterology Unit, La Princesa University Hospital and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain. mariachs2005@gmail.com
authors.forename: María
authors.initials: M
authors.lastname: Chaparro
authors.forename: Almudena
authors.initials: A
authors.lastname: Barbero
authors.forename: Leticia
authors.initials: L
authors.lastname: Martín
authors.forename: Carlos
authors.initials: C
authors.lastname: Esteban
authors.forename: Laura
authors.initials: L
authors.lastname: Espinosa
authors.forename: Felipe
authors.initials: F
authors.lastname: de la Morena
authors.forename: Argeme
authors.initials: A
authors.lastname: Sánchez
authors.forename: Irene
authors.initials: I
authors.lastname: Martín
authors.forename: Cecilio
authors.initials: C
authors.lastname: Santander
authors.forename: Ricardo
authors.initials: R
authors.lastname: Moreno-Otero
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006396:Hematemesis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008551:Melena / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D018579:Patient Selection; D010438:Peptic Ulcer Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome