Lower gastrointestinal bleeding 2015
National Comparative Audit of lower gastrointestinal bleeding and the use of blood (2015)
To characterise the clinical characteristics, management strategies and outcomes of patients with acute lower gastrointestinal bleeding (LGIB) presenting to UK hospitals.
Describe the use of inpatient investigations, treatments including emergency surgery and quantify the volume of blood product transfusion in comparison to established national guidelines and protocols.
Who took part?
We audited 2528 patients from 143 acute hospitals across the United Kingdom over 2 months in 2015.
What did we find?
Full report (PDF)
Lower gastrointestinal bleeding (LGIB) patients
Most LGIB patients were elderly, with other medical problems and often they were taking antiplatelet or anticoagulant medications. Anaemia and shock were very uncommon, but this over 25% patients received a red cell transfusion. Single unit transfusions were used in only 20% cases. Many patients did not have the source of bleeding investigated during their admission, even those with severe bleeding. Patients that were investigated often waited more than 24 hours for crucial tests.
Lower gastrointestinal bleeding services
Treatment of LGIB can be delivered endoscopically, via interventional radiology procedures such as mesenteric embolisation, or surgically. All hospitals provided 24/7 on-site access to surgery, 73% provided 24/7 access to endoscopy and 55% provided 24/7 access to interventional radiology. Most patients with LGIB are admitted under surgical teams, but even though most patients were elderly, only 20% hospitals reported providing surgical patients routine access to specialist elderly care doctors.
The full list of recommendations is included in the audit report (PDF)
Key recommendations are as follows:
- Hospitals have a duty of care to provide acute haemorrhage control. Those that do not provide on-site interventional radiology should liaise with their regional centre to establish an agreed formalised network
- Hospitals should examine their transfusion practice to ensure appropriate transfusion thresholds are being utilised.
- Hospitals should develop comprehensive local guidelines that cover both upper and lower gastrointestinal bleeding, and should include the management of anticoagulants and antiplatelets.
Resources available to help improve practice
Guidance on the safe provision of interventional radiology services has been provided by the Royal College of Radiologists and the British Society of Interventional Radiologists
Full report (PDF)
The methodology, audit tool and auditable standards can be found in the published protocol for the audit
This findings and recommendations from this audit are endorsed by the British Society of Gastroenterology, the British Society of Interventional Radiology, NHS Blood and Transplant and the Association of Coloproctology of Great Britain and Ireland.
This project was jointly funded by NHS Blood and Transplant and the Bowel Disease Research Foundation
Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. The Lancet Gastroenterology & Hepatology 2(9) · June 2017 DOI: 10.1016/S2468-1253(17)30150-4
Provision of interventional radiology, endoscopy and surgery for acute lower gastrointestinal bleeding in the United Kingdom: preliminary results of a national comparative audit. Cardiovasc Intervent Radiol (2016) 39(Suppl 3): 35. https://doi.org/10.1007/s00270-016-1405-3
This audit is on twitter: @LGIBaudit