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Predicting clinical outcomes after acute upper gastrointestinal haemorrhage
Başlık:
Predicting clinical outcomes after acute upper gastrointestinal haemorrhage
Yazar:
Blatchford, Oliver, author.
ISBN:
9780438060043
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (327 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 76-08C.
Advisors: Lindsay Davidson.
Özet:
Main aims: To develop a risk score that may be used to predict patients' risks of needing treatment following an episode of upper gastrointestinal haemorrhage. To validate this risk score, comparing it to an existing risk score. Literature review: The epidemiology of upper gastrointestinal haemorrhage, particularly in the United Kingdom, was reviewed. Estimation of the pooled incidence and case fatality data for upper gastrointestinal haemorrhage in the United Kingdom was undertaken. This was not possible due to the heterogeneity of reported epidemiological estimates. The implications of these new epidemiological findings were discussed. Risk factors and outcome risk markers for upper gastrointestinal haemorrhage were then considered. Particular attention was given to the significance of the association between patients' blood urea values and upper gastrointestinal haemorrhage, with a historical review of papers discussing this association. Existing published risk prediction systems for upper gastrointestinal haemorrhage outcomes were critically reviewed. Setting: The score was developed using data collected during an audit outcomes following upper gastrointestinal haemorrhage in all 18 acute hospital units in the west of Scotland. These included district general hospitals and university teaching hospitals. The score was evaluated using data prospectively collected in three of these hospitals. Subjects Data representing 1,534 patients' admissions were used to build the upper gastrointestinal haemorrhage risk score, which was then validated using data from another 198 patients' admissions. Methods: Logistic regression analyses were used to identify risk markers for inclusion in the risk score. Logistic regression coefficients were transformed into component values for the risk score. The score's discrimination was assessed by calculating areas under the ROC curves for the score, comparing these with ROC curve areas for the Rockall scoring system. The score's calibration was assessed using the Hosmer-Lemeshow goodness-of-fit statistic. Results: A simple additive risk scoring system, based on eight items of data available at the time of patients' admissions to hospital was constructed. These data items were patients' admission haemoglobin and urea values, their systolic blood pressure and pulse, and whether they presented with syncope, melaena, cardiac failure or a history of hepatic disease. A simplified "fast track" risk prediction tool, based on the first four of these data items was also constructed. The risk score was well calibrated for predicting patients' need for clinical intervention. The Hosmer-Lemeshow statistic was 5.72 (p = 0.77).The risk score had a good ability to discriminate patients' needs for clinical intervention with an area under the ROC curve of 0.919. This compared with the ROC curve areas for the same outcome of 0.703 for the Rockall pre-endoscopy score and 0.774 for the full (post-endoscopy) Rockall score. The simplified "fast track" risk prediction tool was able to identify 99% of patient who needed clinical intervention (sensitivity) and it was able to identify 41% of those who did not require any clinical intervention (specificity). Conclusions: Following further validation, this new risk score may improve triage of upper gastrointestinal haemorrhage patients in the emergency department, enabling some of those patients at lowest risk to be discharged with arrangements for outpatient investigation. This new risk score may be also clinically useful to identify those patients at greatest risk following upper gastrointestinal haemorrhage, so that they may be managed more intensively.
Notlar:
School code: 0547
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(684781.1) | 684781-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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