Gastrointestinal endoscopy 06/2012; 75(6):1290-1. DOI:10.1016/j.gie.2012.01.030 · 5.37 Impact Factor
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ABSTRACT: Nasogastric lavage (NGL) is often performed early in the management of GI bleeding. This practice assumes that NGL results can assist with timely risk stratification and management.
We performed a retrospective analysis to test whether NGL is associated with improved process measures and outcomes in GI bleeding.
Propensity-matched retrospective analysis.
University-based Veterans Affairs medical center.
A total of 632 patients admitted with GI bleeding.
Thirty-day mortality rate, length of hospital stay, transfusion requirements, surgery, and time to endoscopy.
Patients receiving NGL were more likely to take nonsteroidal anti-inflammatory drugs and be admitted to intensive care, but less likely to have metastatic disease or tachycardia, be taking warfarin, or present on weekdays. After propensity matching, NGL did not affect mortality (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.37-1.92), length of hospital stay (7.3 vs 8.1 days, P = .57), surgery (OR 1.51; 95% CI, 0.42-5.43), or transfusions (3.2 vs 3.0 units, P = .94). However, NGL was associated with earlier time to endoscopy (hazard ratio 1.49; 95% CI, 1.09-2.04), and bloody aspirates were associated high-risk lesions (OR 2.69; 95% CI, 1.08-6.73).
Performing NGL is associated with the earlier performance of endoscopy, but does not affect clinical outcomes. Performing NGL at initial triage may promote more timely process of care, but further studies will be needed to confirm these findings.
Gastrointestinal endoscopy 07/2011; 74(5):971-80. DOI:10.1016/j.gie.2011.04.045 · 5.37 Impact Factor
Gastroenterology 05/2010; 138(5). DOI:10.1016/S0016-5085(10)60407-6 · 16.72 Impact Factor
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ABSTRACT: Despite data that traditional laboratory-based outcome measures in dialysis are improving over time, population-based data indicate that mortality rates are not improving in parallel. With increased focus on performance measures based on laboratory-based outcomes (e.g., hematocrit, albumin, and parathyroid hormone), less emphasis has been placed on other markers, some of which may be stronger predictors of mortality. We performed a systematic review to interpret the predictive value of laboratory-based outcome measures in dialysis. We identified studies with data regarding the predictive value of laboratory-based outcomes for mortality in dialysis. We calculated the sample size-weighted pooled relative risk of death with dichotomized "high" vs. "low" levels of each measure. We rank-ordered predictors by scaling the pooled relative risk of each measure by its pooled standard deviation. There were 5171 titles, of which 128 (representing 44 laboratory-based outcomes) were selected. Nine were significantly associated with mortality, in order of decreasing scaled effect size: (1) tumor necrosis factor-alpha, (2) hematocrit, (3) interleukin-6, (4) troponin T, (5) Kt/V(urea), (6) prealbumin, (7) urea reduction ratio, (8) serum albumin, and (9) C-reactive protein. Other oft-cited measures such as calcium phosphate product and parathyroid hormone were not significantly associated with mortality in pooled analysis. Quality improvement efforts to improve traditional laboratory-based outcomes in end-stage renal disease are necessary, but likely insufficient, to improve overall mortality in dialysis. Renewed consideration of cardiovascular, inflammatory, and nutritional markers that are especially strong predictors of mortality may have important implications for risk stratification and targeted therapeutic interventions.
Hemodialysis International 08/2009; 13(3):347-59. DOI:10.1111/j.1542-4758.2009.00377.x · 1.24 Impact Factor
Gastroenterology 05/2009; 136(5). DOI:10.1016/S0016-5085(09)62798-0 · 16.72 Impact Factor
Gastroenterology 05/2009; 136(5). DOI:10.1016/S0016-5085(09)62795-5 · 16.72 Impact Factor
Gastroenterology 04/2008; 134(4). DOI:10.1016/S0016-5085(08)60154-7 · 16.72 Impact Factor