A simple clinical score to stratify the risk of procedure-related adverse events in ERCP procedures with trainee involvement.
Endoscopy
; 55(9): 804-811, 2023 09.
Article
em En
| MEDLINE
| ID: mdl-36828031
ABSTRACT
BACKGROUND:
Optimal training strategies in endoscopic retrograde cholangiopancreatography (ERCP) remain controversial despite the shift toward competence-based training models, with limited data available on patient safety during training. We aimed to assess whether pre-procedural clinical predictors could identify patients at low risk of developing procedure-related adverse-events (AEs) in a training environment.METHODS:
We performed a prospective, multicenter, cohort study in five training centers. A data collection system documenting indication, clinical data, trainee performance (assessed using a validated competence assessment tool), technical outcomes, and AEs over a 30-day follow-up was utilized. We developed a clinical risk score (Trainee Involvement in ERCP Risk Score [TIERS]) for patients undergoing ERCP and compared the rate of AEs in a training environment between low-risk and high-risk groups. The association between trainee performance and AE rate was also evaluated.RESULTS:
1283 ERCPs (409 [31.9â%, 95â%CI 29.3â%-34.4â%] with trainee involvement) performed by 11 trainers and 10 trainees were analyzed. AEs were more frequent in the high-risk compared with the low-risk group 26.7â% (95â%CI 20.5â%-34.7â%) vs. 17.1â% (95â%CI 12.8â%-22.2â%). TIERS demonstrated a high negative predictive value for AEs (82.9â%, 95â%CI 79.4â%-85.8â%) and was the only predictor of AEs on multivariable analysis (odds ratio 1.38, 95â%CI 1.09-1.75). Suboptimal trainee performance was associated with an increase in AE rates.CONCLUSION:
Simple, clinical-based predictive tools could improve ERCP training by selecting the most appropriate cases for hands-on training, with the aim of increasing patient safety.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Colangiopancreatografia Retrógrada Endoscópica
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Competência Clínica
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Endoscopy
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Romênia