{
  "abstract": "Acute paediatric GI bleeding is a rare but serious presentation and can be associated with significant morbidity and mortality. Previous prospective surveys have attempted to establish incidence and specific clinical data regarding GI bleeding. 1 Data regarding the configuration and delivery of GI bleeding services on a national basis are lacking. This survey aimed to establish how services are delivered, number of cases managed and frequency of morbidity and mortality with purpose of informing the development of a national GI bleeding practice framework. Units were invited to complete an online survey through the British Society for Paediatric Gastroenterology (BSPGHAN) then by directly contacting units to contribute. There were 20 responses from 17 centres indicating 57% survey coverage based on there being approximately 30 centres in the UK.2 15/17 of centres managed acute GI bleeding, of these 13/15 had gastroenterologists managing bleeding 24/7. In some centres, bleeding patients were managed by the surgical team or had direct input from adult services out-of-hours. The number of whole-time-equivalent consultants providing services varied considerably from 1 to 9 with a median of 5. 5/18 centres routinely used the Sheffield scoring system, 8/18 used the BSPGHAN bleeding pathway and the majority used a local guideline. 14/18 had access to adult support with some having formalised agreements but most on an informal basis. Interventional radiology (IR) support was highly variable with only one centre having 24/7 paediatric IR access but the majority had potential access to adult IR on-call. Equipment access was robust, with most centres having a dedicated GI bleeding trolley/kit (16/18) and near ubiquitous access to haemospray (17/18), endoclips (16/18) and band ligators (15/18). 13/18 of centres had Sengstaken-Blakemore tubes available for refractory bleeding. The annual case volume for acute GI bleeding interventions showed significant variation between centres (median=3.5, range=0-24), classifying it as a low-volume procedure in many settings. Reported clinical outcomes were favourable with the majority of centres reporting no mortality or significant morbidity due to acute bleeding in the last 12 months. Considering departmental confidence in managing bleeding, 72% of centres reported excellent or very good confidence in-hours compared to 28% excellent or very good out-of-hours. 7/20 centres had simulation or up-skilling sessions. This is the first project to survey acute paediatric GI bleeding services in the UK. These preliminary data indicate there is significant heterogeneity in how services are configured across the country particularly in terms of adult, surgical and IR support. Risk scores and national pathways are not universally used indicating there is scope to improve their utility. Case volume is generally low and morbidity and mortality is rare. Establishment of a prospective national bleeding registry could improve resource provision and inform efforts to standardise services.References Thorn N, Vallorani M, Kirupananthan R, et al. P20 Emergenci: a UK prospective survey of severe GI bleeding (requiring upper GI endoscopy) and emergency endoscopy in under 16s. Frontline Gastroenterology 2021;12:A22–A23.Royal College for Paediatrics and Child Health/British Society for Paediatric Gastroenterology, Hepatology and Nutrition. The paediatric gastroenterology, hepatology and nutrition UK national census 2021. 2021.Abstract OC70 Figure 1Map of the UK with responding centres, green centres provide acute manage of GI bleeding and blue centres provide gastroenterology services but not bleeding management",
  "authors": [
    {
      "affiliations": [
        "Royal Hospital for Children and Young People, Edinburgh"
      ],
      "name": "David Cairney"
    },
    {
      "affiliations": [
        "Sheffield Children’s Hospital"
      ],
      "name": "Shishu Sharma"
    }
  ],
  "title": "OC70 The national BSPGHAN GI bleeding survey – the state of play in UK paediatric bleeding services",
  "uid": "8354a3bc-53f2-55d1-9f92-cd7c4c345af3"
}