Prognostic indices of upper gastrointestinal bleeding in patients in the Emergency Department
Keywords:esophagogastroduodenoscopy, gastrointestinal hemorrhage, emergency department length of stay, mortality
Objectives Upper gastrointestinal bleeding (UGIB) is a common but potentially fatal condition often seen in the emergency department (ED). This study aimed to investigate prognostic factors, including the emergency department length of stay (ED LOS), office hours vs. non-office hours visits, performance of an esophagogastroduodenoscopy (EGD) including time from admission to performance of the EGD which could potentially affect in-hospital all-cause mortality.
Methods A retrospective study was conducted of patients with UGIB in the ED of Maharaj Nakorn Chiang Mai Hospital during 2017. Univariable and multivariable logistic regression were used.
Results A total of 132 patients were included with a total of 19 deaths (14.4%). Logistic regression showed the presence of any liver disease, systolic blood pressure < 90 mmHg, hemoglobin ≤ 7 g/dL, platelet count ≤ 100,000 per mm3, International Normalized Ratio (INR) ≥1.2, a high Glasgow-Blatchford bleeding score, intravenous fluid ≥1,000 mL, administration of blood components, use of octreotide and/or tranexamic acid were found to be associated with increased mortality (p < 0.05). There was no evidence that either ED LOS ≥ 180 minutes after admission or a non-office hours visit were associated with mortality (p > 0.05) although EGD following admission was associated with decreased mortality (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.07 to 0.52, p = 0.001). In multivariable analysis, only EGD following admission (OR 0.01, 95% CI 0.01 to 0.1, p = 0.001) was associated with decreased mortality. In multivariable subgroup analysis, no evidence was found that EGD within the first 24 hours after admission (early EGD) was related to decreased mortality compared with EGD after the first 24 hours (late EGD).
Conclusions EGD following hospital admission can decrease mortality. However, there was no evidence that a longer ED LOS, whether admission occurred during office hours or outside of office hours or early vs. late EGD were associated with in-hospital all-causes mortality.
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