Goals: 

The aim was to investigate the impact of night-time emergency department (ED) presentation on outcomes of patients admitted for acute upper gastrointestinal hemorrhage (UGIH).

Background: 

The relationship between time of ED presentation and outcomes of gastrointestinal hemorrhage is unclear.

Study: 

Using the 2016 and 2017 Florida State Inpatient Databases which provide times of ED arrival, we identified and categorized adults hospitalized for UGIH to daytime (07:00 to 18:59 h) and night-time (19:00 to 06:59 h) based on the time of ED presentation. We matched both groups with propensity scores, and assessed their clinical outcomes including all-cause in-hospital mortality, in-hospital endoscopy utilization, length of stay (LOS), total hospitalization costs, and 30-day all-cause readmission rates.

Results: 

Of the identified 38,114 patients with UGIH, 89.4% (n=34,068) had acute nonvariceal hemorrhage (ANVH), while 10.6% (n=4046) had acute variceal hemorrhage (AVH). Compared with daytime patients, ANVH patients admitted at night-time had higher odds of in-hospital mortality (odds ratio: 1.32; 95% confidence interval: 1.06-1.60), lower odds of in-patient endoscopy (odds ratio: 0.83; 95% confidence interval: 0.77-0.90), higher total hospital costs ($9911 vs. $9545, P<0.016), but similar LOS and readmission rates. Night-time AVH patients had a shorter LOS (5.4 vs. 5.8 d, P=0.045) but similar mortality rates, endoscopic utilization, total hospitalization costs, and readmission rates as daytime patients.

Conclusions: 

Patients arriving in the ED at night-time with ANVH had worse outcomes (mortality, hospitalization costs, and endoscopy utilization) compared with daytime patients. However, those with AVH had comparable outcomes irrespective of ED arrival time.

中文翻译：

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夜间急诊就诊对上消化道出血结局的影响

目标： 

目的是调查夜间急诊科 (ED) 就诊对因急性上消化道出血 (UGIH) 入院的患者结局的影响。

背景： 

急诊就诊时间与胃肠道出血结局之间的关系尚不清楚。

学习： 

使用提供 ED 到达时间的 2016 年和 2017 年佛罗里达州住院患者数据库，我们将因 UGIH 住院的成人确定并分类为白天（07:00 至 18:59 h）和夜间（19:00 至 06:59 h）基于 ED 呈现的时间。我们将两组与倾向评分进行匹配，并评估了他们的临床结果，包括全因住院死亡率、住院内镜检查利用率、住院时间 (LOS)、总住院费用和 30 天全因再入院率。

结果： 

在确定的 38,114 名 UGIH 患者中，89.4% (n=34,068) 患有急性非静脉曲张出血 (ANVH)，而 10.6% (n=4046) 患有急性静脉曲张出血 (AVH)。与白天入院的 ANVH 患者相比，夜间入院的 ANVH 患者院内死亡率更高（优势比：1.32；95% 置信区间：1.06-1.60），住院内镜检查的优势更低（优势比：0.83；95 % 置信区间：0.77-0.90），住院总费用较高（9911 美元对 9545 美元，P <0.016），但 LOS 和再入院率相似。夜间 AVH 患者的 LOS 较短（5.4 天与 5.8 天，P = 0.045），但死亡率、内镜使用率、总住院费用和再入院率与白天患者相似。

结论： 

与白天患者相比，夜间到达急诊室的 ANVH 患者的结局（死亡率、住院费用和内窥镜检查使用率）更差。然而，无论 ED 到达时间如何，患有 AVH 的患者都有可比的结果。