Study protocol: first nationwide comparative audit of acute lower gastrointestinal bleeding in the UK

Abstract

IntroductionAcute lower gastrointestinal bleeding (LGIB) is a common indication for emergency hospitalisation worldwide. In contrast to upper GIB, patient characteristics, modes of investigation, transfusion, treatment and outcomes are poorly described. There are minimal clinical guidelines to inform care pathways and the use of endoscopy, including (diagnostic and therapeutic yields), interventional radiology and surgery are poorly defined. As a result, there is potential for wide variation in practice and clinical outcomes.Methods and analysisThe UK Lower Gastrointestinal Bleeding Audit is a large nationwide audit of adult patients acutely admitted with LGIB or those who develop LGIB while hospitalised for another reason. Consecutive, unselected presentations with LGIB will be enrolled prospectively over a 2-month period at the end of 2015 and detailed data will be collected on patient characteristics, comorbidities, use of anticoagulants, transfusion, timing and modalities of diagnostic and therapeutic procedures, clinical outcome, length of stay and mortality. These will be audited against predefined minimum standards of care for LGIB. It is anticipated that over 80% of all acute hospitals in England and some hospitals in Scotland, Wales and Northern Ireland will participate. Data will be collected on the availability and organisation of care, provision of diagnostic and therapeutic GI endoscopy, interventional radiology, surgery and transfusion protocols.Ethics and disseminationThis audit will be conducted as part of the national comparative audit programme of blood transfusion through collaboration with specialists in gastroenterology, surgery and interventional radiology. Individual reports will be provided to each participant site as well as an overall report and disseminated through specialist societies. Results will also be published in peer-reviewed journals. The study has been funded by National Health Services (NHS) Blood and Transplant and the Bowel Disease Research Foundation and endorsed by the Association of Coloproctology of Great Britain and Ireland.

Outcomes following restrictive or liberal red blood cell transfusion in patients with lower gastrointestinal bleeding

“…In the UK, GI bleeding is the most common indication for RBC transfusion after haematological malignancy; over one‐third of these transfusions are for LGIB . The estimated cost saving for the UK National Health Service in implementing restrictive RBC transfusion is £3.3 m per year for UGIB alone . This has important implications for resource utilisation considering the age and comorbidity of our LGIB population.…”

“…We conducted a post hoc analysis of the UK National Audit of LGIB and the Use of Blood, a large prospective cohort study of LGIB conducted in 2015 . The methodology of the primary study is previously described, but in brief consecutive, unselected adult presentations with LGIB presenting to UK hospitals from 1 September 2015 for 2 months were eligible. This included new presentations with LGIB as well as those developing LGIB while admitted for another reason .…”

Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit

“…The study protocol has previously been published in full 9. This audit was undertaken as part of the NHS Blood and Transplant National Comparative Audit of Blood Transfusion programme, which supports research to improve the evidence base for transfusion in patients with GI bleeding 10 11.…”

“…All were invited to participate in June 2015 9. The audit was also advertised to NHS hospitals in Scotland, Wales and Northern Ireland via their national blood services.…”

“…Standards were adopted from transfusion and UGIB guidelines,21 22 or where none exist, expert consensus and published a priori in the study protocol 9…”