scholarly journals Blatchford Score Is Superior to AIMS65 Score in Predicting the Need for Clinical Interventions in Elderly Patients with Nonvariceal Upper Gastrointestinal Bleed

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Khalid Abusaada ◽  
Fnu Asad-ur-Rahman ◽  
Vladimir Pech ◽  
Umair Majeed ◽  
Shengchuan Dai ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Care Center ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Gastrointestinal Bleed ◽  
Upper Gastrointestinal Bleed ◽  
Upper Gastrointestinal ◽  
Operator Curve

Background. Blatchford and AIMS65 scores were developed to risk stratify patients with upper gastrointestinal bleed (UGIB). We sought to assess the performance of Blatchford and AIMS65 scores in predicting outcomes in elderly patients with nonvariceal UGIB.Methods. A retrospective cohort study of elderly patients (over 65 years of age) with nonvariceal UGIB admitted to a tertiary care center. Primary outcome was a combined outcome of in-hospital mortality, need for any therapeutic endoscopic, radiologic, or surgical intervention, rebleeding within 30 days, or blood transfusion. Secondary outcome was a combined outcome of in-hospital mortality or need for an intervention to control the bleed.Results. 164 patients were included. The primary outcome occurred in 119 (72.5%) patients. The secondary outcome occurred in 12 patients (7.2%). Blatchford score was superior to AIMS65 score in predicting the primary outcome (area under the receiver-operator curve (AUROC) 0.84 versus 0.68, resp.,p<0.001). Both scores performed poorly in predicting the secondary outcome (AUROC 0.56 versus 0.52, resp.,p=0.18).Conclusions. Blatchford score could be useful in predicting the need for hospital based interventions in elderly patients with nonvariceal UGIB. Blatchford and AIMS65 scores are poor predictors of the need for a therapeutic intervention to control bleeding.

scholarly journals Clinical Profile and Endoscopic Findings in Patients with Upper Gastrointestinal Bleed Attending a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2020 ◽  
Vol 58 (226) ◽  
Author(s):  
Subash Bhattarai
Keyword(s):  
Upper Gastrointestinal Bleeding ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Medical Emergency ◽  
Sectional Study ◽  
Cross Sectional ◽  
Gastrointestinal Bleed ◽  
Upper Gastrointestinal Bleed ◽  
Rockall Score ◽  
Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is a common acute medical emergency. Endoscopyis the gold standard diagnostic and therapeutic tool in the management of upper gastrointestinalbleed. This study was undertaken to address the clinical profile, endoscopic profile, and outcomes inpatients with upper gastrointestinal bleed. Methods: A descriptive cross-sectional study was conducted in a tertiary care teaching hospital inGandaki Province, Nepal from January 2018 to December 2019 after obtaining ethical clearancefrom Institutional Review Committee (MEMG/IRC/291/GA) and informed consent fromthe patient or patient relatives. The sample size was calculated. Six hundred and sixty patientswith upper gastrointestinal bleed were included in the study. Data entry was done in StatisticalPackages for the Social Sciences version 20. Results: Peptic ulcers and ruptured oesophageal varices are the common aetiologies of uppergastrointestinal bleed. Inpatient mortality was seen in 98 (14.8 %) patients. Upper gastrointestinalbleed of variceal etiology presents with a higher Rockall score and has more chances of rebleedingand has higher mortality than those with non-variceal aetiologies. Bad prognostic factors wererebleeding, variceal etiology, and comorbidities including cirrhotic and Rockall score > 6. Conclusions: Upper gastrointestinal bleeding is a common acute medical emergency. Early uppergastrointestinal endoscopy preferably within 24 hours is recommended for diagnosis, timelyintervention, and management of the patients with an upper gastrointestinal bleed that helps inreducing morbidity and mortality.    

scholarly journals Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Aqeela J. Madan ◽  
Fayza Haider ◽  
Saeed Alhindi
Keyword(s):  
Seasonal Variation ◽  
Success Rate ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Intervention ◽  
Secondary Outcome ◽  
Lead Point ◽  
Pneumatic Reduction ◽  
Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Davide Cao ◽  
Matthew A Levin ◽  
Samantha Sartori ◽  
Anastasios Roumeliotis ◽  
Rishi Chandiramani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Bleeding Events ◽  
Target Vessel Revascularization ◽  
Increased Risk

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.

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