title: A national survey on the initial management of upper gastrointestinal bleeding.
abstract: OBJECTIVE
  To evaluate the initial management of upper gastrointestinal (GI) bleeding in the United States.
  
  
  BACKGROUND
  Various guidelines have addressed the initial management of upper GI bleeding, but the extent to which these guidelines are followed in clinical practice is unknown.
  
  
  METHODS
  We conducted a national survey of emergency physicians, internists, and gastroenterologists practicing in hospitals affiliated with an ACGME-accredited gastroenterology fellowship. Participants rated their agreement and adherence to 9 preendoscopic quality indicators for the initial management of upper GI bleeding. Awareness, use, and barriers to the use of early prognostic risk scores were also assessed.
  
  
  RESULTS
  A total of 1402 surveys were completed, with an estimated response rate of 11.3%. Gastroenterologists and trainees agreed with the quality indicators more than nongastroenterologists and attending physicians, respectively. There was no difference in the application of the quality indicators by specialty or clinical position. Among all physicians, 53% had ever heard of and 30% had ever used an upper GI bleeding risk score. More gastroenterologists than nongastroenterologists had heard of (82% vs. 44%, P<0.001) and used (51% vs. 23%, P<0.001) a risk score. There was no difference between attending physicians and trainees. Gastroenterologists and attending physicians more often cited lack of utility as a reason to not use risk scores, whereas nongastroenterologists and trainees more often cited lack of knowledge.
  
  
  CONCLUSIONS
  Among emergency physicians, internists, and gastroenterologists in the United States, agreement with upper GI bleeding initial management guidelines was high but adherence--especially pertaining to the use of risk scores--was low.
authors: *Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, WA †Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Peter S
authors: PS
authors: Liang
authors: John R
authors: JR
authors: Saltzman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005762:Gastroenterology / Q000592:standards; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000592:standards; D006801:Humans; D007388:Internal Medicine / Q000592:standards; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013038:Specialization; D016896:Treatment Outcome; D014481:United States