Prospective evaluation of a clinical guideline recommending early patients discharge in bleeding peptic ulcer.
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.
Chaparro
María
M
Gastroenterology Unit, La Princesa University Hospital and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain. mariachs2005@gmail.com
Barbero
Almudena
A
Martín
Leticia
L
Esteban
Carlos
C
Espinosa
Laura
L
de la Morena
Felipe
F
Sánchez
Argeme
A
Martín
Irene
I
Santander
Cecilio
C
Moreno-Otero
Ricardo
R
Gisbert
Javier P
JP
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