J Korean Soc Emerg Med.  2021 Oct;32(5):386-393.

Usefulness of critical pathway for variceal upper gastrointestinal bleeding in the emergency department for the treatment and prognosis of patients

• Lee J
• You JS
• Park GE
• Park Jy
• Chung SP
• Kong TY
• Beom JH
• Ko DR

Abstract

Objective
Endoscopic hemostasis is a key treatment for variceal upper gastrointestinal bleeding. However, the effects of early endoscopy in variceal upper gastrointestinal bleeding have not been sufficiently studied. This study investigated the effects of the use of the critical pathway (CP) for upper gastrointestinal bleeding.
Methods
The study was designed as a ‘before and after’ study. A group of patients diagnosed with variceal upper gastrointestinal bleeding from January 1, 2011, to December 31, 2014, and CP activated patients from January 1, 2015, to December 31, 2018, were reviewed retrospectively. The study endpoints included an analysis of the following in the two groups: time from emergency department (ED) arrival to endoscopy, number of blood transfusions, hospitalization period, intensive care unit (ICU) admission, 30-day mortality.
Results
From January 1, 2011, to December 31, 2018, 207 patients were admitted with variceal upper gastrointestinal bleeding, and 137 patients with a Blatchford score of 7 or higher were included in the study. Of these, 88 patients visited before the implementation of CP and 49 patients visited thereafter. The time from ED arrival to endoscopy was 218.1±201.7 minutes in the CP activated group, which was about 200 minutes shorter (P=0.046) than the non-CP group. There was no statistical difference in 30-day mortality, transfusion, emergency room hospitalization time, number of ICU admissions, and hospitalization days (P=0.348, P=0.394, P=0.651, P=0.164, and P=0.069).
Conclusion
After CP, the time to endoscopy was significantly shortened, but it did not reduce mortality.

Keyword

Gastrointestinal hemorrhage; Esophageal varices; Gastric varices; Endoscopy; Hemostasis; Critical pathways