Impacting cost and appropriateness of stress ulcer prophylaxis at a university medical center

Erstad, Brian L.; Camamo, James M.; Miller, Michael J.; Webber, Anthony M.; Fortune, John B.

doi:10.1097/00003246-199710000-00017

Cited by 49 publications

(27 citation statements)

References 23 publications

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“…As a consequence, it is possible that patients who developed GI hemorrhage had received prophylactic medications for a shorter period of time. Moreover, the evidence [16, 17, 31] strongly suggests that stress ulcer prophylaxis should be limited to patients with established risk factors for GI hemorrhage. We believe that identifying risk factors can provide a valid predictive tool for GI bleeding that will allow clinicians to prescribe prophylactic treatment to the stroke patients who are most likely to benefit from it.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Hemorrhage after Acute Ischemic Stroke and Its Risk Factors in Asians

et al. 2009

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Background: The aim of this study was to examine the frequency and risk factors of gastrointestinal (GI) hemorrhage in acute ischemic stroke patients in Taiwan. Method: 920 patients admitted for acute ischemic stroke from January 2001 to October 2005 were included in the study. We reviewed the available medical records for any episode of GI hemorrhage, possible precipitating factors and administration of ulcer prophylaxis. Results: Seventy-two patients (7.8%) experienced GI hemorrhage; these patients were of an older age (74.7 vs. 69.0 years, p < 0.001), had a longer acute ward stay (30.4 vs. 12.9 days, p < 0.001) and higher mortality rate (odds ratio 9.61, CI 4.53–20.42) than patients without GI hemorrhage. In multivariate logistic regression analysis, the important risk factors of GI hemorrhage included sepsis, previous history of GI hemorrhage, severe stroke, renal insufficiency and abnormal liver function. Of the 779 patients who had a 0–1 risk factor, 26 (3.3%) experienced GI hemorrhage; of the 27 patients with more than 2 risk factors, 17 (63%) suffered GI hemorrhage. Conclusion: This study of Asians revealed a higher frequency of GI hemorrhage after acute ischemic stroke than that reported in previous studies, and the frequency of GI hemorrhage was positively correlated with the number of risk factors present. We suggest that identifying stroke patients with a high risk of hemorrhage may allow clinicians to set up ulcer prophylactic protocols for the patients most likely to benefit, especially in an Asian population.

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal Hemorrhage after Acute Ischemic Stroke and Its Risk Factors in Asians

et al. 2009

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“…Sucralfate may be as effective in reducing bleeding as gastric pH-altering drugs and may be associated with lower rates of pneumonia and mortality. Appropriate stress ulcer prophylaxis among ICU patients reduces both hospital stays and increased costs due to clinically significant bleeding [170].…”

Section: Category 15: Gastric Ulcer Prophylaxismentioning

confidence: 99%

Intracerebral Hemorrhage Specific Intensity of Care Quality Metrics

Qureshi

2010

Neurocrit Care

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The next step in development of a new ICH specific intensity of care quality metrics is validation and refinement of the quality indicators and thresholds presented in the current report. Future activities may include selection and validation based on consensus of experts and application of the system to a large series of patients with ICH and assessment of relationship of components in isolation and as a group to outcome after severity adjustment.

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“…Therefore, SUP was significantly better practised in teaching hospitals. Such results are not surprising because teaching hospitals are more likely to follow guidelines and recommendations [63,64] . This study reinforces the results of previous studies undertaken in the Middle East.…”

mentioning

confidence: 97%

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

Zeitoun

Zeineddine²,

Dimassi³

2011

WJGPT

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AIM:To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers. METHODS:A multi-center prospective chart review study was conducted over 8 mo. A questionnaire was distributed to pharmacy students who collected data on demographics, SUP medications, dose, route, duration and associated risk factors. The appropriateness of SUP use was determined as per American Society of Health-System Pharmacists guidelines. Institutional review board approval was obtained from each hospital center. RESULTS:A total of 1004 patients were included. 67% of the patients who received prophylaxis did not have an indication for SUP. The majority (71.6%) of the patients who were administered parenteral drugs can tolerate oral medications. Overall, the regimen of acid-suppressant drugs was suboptimal in 87.6% of the sample. This misuse was mainly observed in nonteaching hospitals. CONCLUSION:This study highlighted the need, in Lebanese hospitals, to establish clinical practice guidelines for the use of SUP; mainly in non-critical care settings.

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Impacting cost and appropriateness of stress ulcer prophylaxis at a university medical center

Abstract: Cost savings are associated with more appropriate stress ulcer prophylaxis. Clinically important bleeding is uncommon but results in prolonged hospital stays and increased costs.

Cited by 49 publications

References 23 publications

Gastrointestinal Hemorrhage after Acute Ischemic Stroke and Its Risk Factors in Asians

Gastrointestinal Hemorrhage after Acute Ischemic Stroke and Its Risk Factors in Asians

Intracerebral Hemorrhage Specific Intensity of Care Quality Metrics

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

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