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Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis
Published on: December 18, 2010
Clinical audit: recent practice in caring for patients with acute severe colitis compared with published
A H Lim1, R Grafton, D J Hetzel
1University of Adelaide, Adelaide, South Australia, Australia. amanda.h.lim@student.adelaide.edu.au
Internal Medicine Journal
|November 27, 2012
Summary
Adherence to acute severe colitis guidelines is suboptimal, with opportunities for improved care including formal severity assessments and prompt colonic examination. Admission under non-gastroenterology teams may hinder optimal management.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Internal Medicine
Background:
- Acute severe colitis (ASC) poses significant risks, including emergency colectomy and mortality.
- Validated clinical guidelines aim to mitigate these severe outcomes.
Purpose of the Study:
- To assess local adherence to ASC management guidelines.
- To identify areas for care improvement and potential barriers to guideline adherence.
Main Methods:
- Retrospective audit of ASC admissions over two years (2009-2010) at a major metropolitan hospital.
- Case identification via ICD-10 codes for colitis, colectomy, ulcerative colitis, and Crohn disease.
Main Results:
- Only 26% of ASC admissions received comprehensive management including key investigations and prophylaxis.
- Formal severity scoring was rarely documented (1 patient on admission, 9 on day 3).
- Four patients (13%) required colectomy, with three receiving cyclosporine pre-operatively.
Conclusions:
- Care optimization is needed, focusing on formal severity assessments, enhanced venous thromboembolism prophylaxis, and timely colonic examination.
- Management by non-gastroenterology teams was identified as a potential barrier to optimal care.
- Despite suboptimal adherence, the colectomy rate remained acceptably low at 20%.
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