title: Admission time is associated with outcome of upper gastrointestinal bleeding: results of a multicentre prospective cohort study.
abstract: BACKGROUND
  It has been suggested that patients presenting with upper gastrointestinal bleeding (UGIB) during the weekend have a worse outcome compared with weekdays, with an increased risk of recurrent bleeding and mortality.
  
  
  OBJECTIVE
  To investigate the association between timing of admission and adverse outcome after UGIB.
  
  
  METHODS
  We prospectively collected data from patients presenting with symptoms suggestive of UGIB to the emergency room of eight participating hospitals. Using standard descriptive statistics and logistic regression analyses, differences in 30-day mortality, rebleeding rate, and need for angiography and surgical intervention were assessed for week- and weekend admissions and time of admission. Moreover, patient- and procedure-related factors were identified that could influence outcome.
  
  
  RESULTS
  In total, 571 patients were included with suspected UGIB. Patient admitted during the weekend had a higher mortality rate than patients admitted during the week [9% vs.3%; adjusted odds ratio 2.68 (95%CI 1.07-6.72)]. Weekend admissions were not associated with other adverse outcomes. Patients admitted during the weekend presented more often with bleeding and had a significantly lower systolic and diastolic blood pressure. No differences were found in procedure-related factors. Time of admission was not associated with an adverse outcome, although patients admitted during the evening had a significantly longer time to endoscopy (15, 22 and 16 h for day, evening and night admissions respectively, P < 0.01).
  
  
  CONCLUSIONS
  Although quality of care did not appear to differ between week/weekend admissions, patients with suspected upper gastrointestinal bleeding admitted during the weekend were at higher risk of an adverse outcome. This might be due to the fact that these patients have more severe haemorrhage.
authors: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. n.l.degroot-3@umcutrecht.nl
authors: N L
authors: NL
authors: de Groot
authors: J H
authors: JH
authors: Bosman
authors: P D
authors: PD
authors: Siersema
authors: M G H
authors: MG
authors: van Oijen
authors: A J
authors: AJ
authors: Bredenoord
mesh_terms: D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D009426:Netherlands; D009551:Night Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors