Table 1:
Patient-level analysis of compliance to guidelines for the management of nonvariceal upper gastrointestinal bleeding
| Guideline | Before intervention, % (no. of patients) | After intervention, % (no. of patients) | Intracluster correlation coefficient | Percentage difference (95% CI) | ||
|---|---|---|---|---|---|---|
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|
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| Experimental group | Control group | Experimental group | Control group | |||
| Primary outcome | ||||||
|
| ||||||
| Endoscopic hemostasis followed by high-dose IV PPI | 13.2 (20/152) | 7.1 (11/155) | 9.8 (14/143) | 4.8 (6/124) | 0.04 | −5.0 (−12.0 to 2.0) |
|
| ||||||
| Secondary outcomes | ||||||
|
| ||||||
| Injection and/or thermal coagulation without clips and bolus IV PPI followed by infusion for 72 h for high-risk ulcers | 8.6 (13/152) | 5.2 (8/155) | 6.3 (9/143) | 4.8 (6/124) | 0.07 | −1.5 (−8.1 to 5.2) |
|
| ||||||
| Injection and/or thermal coagulation with clips and bolus IV PPI followed by 8 mg/h infusion for 72 h and no oral PPI. If the patient received a pre-endoscopy infusion, the absence of bolus IV PPI was ignored | 69.1 (105/152) | 58.7 (91/155) | 57.3 (82/143) | 62.9 (78/124) | 0.18 | 5.6 (−12.7 to 23.8) |
|
| ||||||
| Injection and/or thermal coagulation with clips and pre-endoscopy IV bolus PPI plus 80-mg bolus IV PPI followed by 8 mg/h infusion for 72 h after endoscopy and no oral PPI | 1.3 (2/152) | 1.9 (3/155) | 1.4 (2/143) | 0.8 (1/124) | −0.05 | −0.6 (−2.5 to 1.3) |
|
| ||||||
| Injection and/or thermal coagulation upon endoscopy for high-risk ulcers with clips alone | 81.6 (124/152) | 74.8 (116/155) | 72.7 (104/143) | 72.6 (90/124) | 0.35 | −0.1 (−20.4 to 20.1) |
|
| ||||||
| Injection and/or thermal coagulation without clips for high-risk ulcers alone | 49.3 (75/152) | 56.1 (87/155) | 50.4 (72/143) | 46.8 (58/124) | 0.33 | −3.6 (−25.4 to 18.2) |
|
| ||||||
| 80-mg IV bolus PPI followed by 8 mg/h PPI infusion for 72 h after endoscopy and no oral PPI | 15.3 (27/177) | 10.0 (17/170) | 13.6 (21/155) | 15.9 (24/151) | 0.27 | 2.3 (−12.1 to 16.8) |
|
| ||||||
| 80-mg IV bolus PPI followed by 8 mg/h infusion for 72 h after endoscopy and no oral PPI. If patient received a pre-endoscopy infusion, the absence of bolus IV PPI afterward was ignored | 82.5 (146/177) | 80.0 (136/170) | 81.3 (126/155) | 89.4 (135/151) | 0.06 | 8.1 (−1.4 to 17.6) |
|
| ||||||
| Pre-endoscopy bolus of PPI plus 80-mg bolus IV PPI followed by 8 mg/h infusion for 72 h after endoscopy and no oral PPI | 1.1 (2/177) | 1.8 (3/170) | 1.9 (3/155) | 9.3 (14/151) | 0.35 | 7.3 (−2.9 to 17.5) |
|
| ||||||
| Use of validated scoring system based on a combination of clinical and endoscopic characteristics to stratify patients into low- and high-risk categories | 0.0 (0/402) | 0.2 (1/424) | 1.9 (7/361) | 0.0 (0/389) | 0.19 | −1.9 (−5.0 to 1.1) |
|
| ||||||
| Early endoscopy (in the first 24 h) with risk classification by clinical/endoscopic criteria | 62.9 (253/402) | 65.6 (278/424) | 57.3 (207/361) | 63.1 (245/388) | 0.09 | 5.6 (−5.6 to 16.9) |
|
| ||||||
| No hemostasis for low risk lesion | 88.9 (200/225) | 93.7 (223/238) | 94.2 (196/208) | 89.0 (218/245) | 0.13 | −5.2 (−13.2 to 2.8) |
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| ||||||
| Endoscopic hemostasis for adherent clot | 87.9 (29/33) | 88.0 (22/25) | 80.7 (25/31) | 80.8 (21/26) | 0.09 | 0.1 (−22.9 to 23.1) |
|
| ||||||
| Endoscopic hemostasis for other active bleeding or visible vessel | 85.9 (152/177) | 83.3 (155/186) | 93.5 (143/153) | 86.1 (124/144) | 0.06 | −7.4 (−15.8 to 1.1) |
|
| ||||||
| Low-risk patients who received treatment | 11.1 (25/225) | 6.3 (15/238) | 5.8 (12/208) | 11.0 (27/245) | 0.13 | 5.2 (−2.8 to 13.2) |
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| ||||||
| Low-risk patients not given IV PPI bolus or infusion after endoscopy | 61.8 (139/225) | 59.2 (141/238) | 56.3 (117/208) | 64.1 (157/245) | 0.05 | 8.0 (−2.9 to 18.9) |
Note: CI = confidence interval, IV = intravenous, PPI = proton pump inhibitor.