背景:在英国(UK)和爱尔兰,急性胃肠道出血(GIB)是需要住院治疗的常见手术问题。英国胃肠病学会(BSG)于2019年发布了第一个英国下消化道出血(LGIB)管理指南。我们旨在评估英国和爱尔兰自我报告对BSG临床指导(CG)的依从性。
方法:使用GoogleForms(GoogleLLC,山景,CA).已分发给外科顾问和高级外科从业人员(专家,信托级注册商,和专业注册商)在四个星期内(2021年3月13日至4月5日)在英国和爱尔兰的不同中心。使用社会科学统计软件包(SPSS)第27版(IBMCorp.,Armonk,NY,美国)。
结果:在英国和爱尔兰的18个不同的研究中心共记录了64个反应。顾问和注册服务商的比例几乎相同(34:30,53.1%:46.9%)。大多数受访者来自结直肠手术(65.6%,n=42),其次是普通外科医生(23.4%,n=15)。共有41位受访者(64.1%)承认BSGCG2019实际上适用于他们的中心。大约75%的受访者没有使用或不知道Shock指数或Oakland评分来对患者进行分层。这意味着59%的人选择接受轻微出血的患者。大约36%的人希望对稳定的大出血进行CT血管造影,而37%不知道介入放射学(IR)转诊途径。
结论:对指南的依从性参差不齐,导致LGIB管理实践和可避免的入院发生重大变化。
BACKGROUND: Acute gastrointestinal bleeding (GIB) is a common surgical problem requiring hospitalization in the United Kingdom (UK) and Ireland. The first UK lower gastrointestinal bleeding (LGIB) management guidelines were published in 2019 by the British Society of Gastroenterology (BSG). We aimed to evaluate self-reported adherence to BSG clinical guidance (CG) within the UK and Ireland.
METHODS: A Questionnaire was designed based on LGIB BSG CG 2019 using Google Forms (Google LLC, Mountain View, CA). This was distributed to surgical consultants and senior surgical practitioners (specialists, Trust grade registrars, and specialist registrars) across different centers in the UK and Ireland over four weeks (13th March to 5th April 2021). Data were analyzed using Statistical Package for Social Sciences (SPSS) version 27 (IBM Corp., Armonk, NY, USA).
RESULTS: A total of 64 responses were recorded from 18 different centers in the UK and Ireland. The ratio of consultants and registrars was almost the same (34:30, 53.1%:46.9%). The majority of respondents were from colorectal surgery (65.6%, n=42) followed by general surgeons (23.4%, n=15). A total of 41 respondents (64.1%) admitted that BSG CG 2019 were practically applicable at their center. Approximately 75% of respondents did not use or were unaware of the Shock index or Oakland score to stratify patients. That translated into 59% opting to admit patients with a minor bleed. Around 36% wanted to perform a CT angiogram for a stable major bleed, while 37% were unaware of the interventional radiology (IR) referral pathway.
CONCLUSIONS: There is patchy adherence to the guidelines leading to significant variations in LGIB management practice and avoidable admissions.