Τίτλος:
Differentiation between patients with acute upper gastrointestinal
bleeding who need early urgent upper gastrointestinal endoscopy and
those who do not. A prospective study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objective To differentiate, among patients presented at the emergency
department with acute upper gastrointestinal bleeding, those who need
early urgent upper gastrointestinal endoscopy from those who do not.
Methods Seventeen variables for each patient presenting with upper
gastrointestinal bleeding were prospectively recorded and considered in
a multivariate analysis. We used the presence of active bleeding during
early urgent upper gastrointestinal endoscopy within 12 h from admission
as the end point. The derived score was validated with data from the
next consecutive patients presenting with upper gastrointestinal
bleeding.
Results Among 190 consecutive patients (mean age 63.7+/-16 years; 64.7%
men), active bleeding was observed in 51 patients (26.8%). Four
variables were identified as independent predictors (P<0.05) of active
bleeding in early urgent upper gastrointestinal endoscopy and were used
for the derivation of the following integer-based scoring system: number
of points=6 (fresh blood in nasogastric tube) + 4 (haemodynamic
instability) + 4 (haemoglobin<8 g/dl) + 3 (white blood cell count
>12000/mul). The validation study consisted of 110 patients (71 men;
mean age 66.1+/-14 years; 28 patients [25.5%] with active bleeding).
In this study, a cut off of <7 points indicated absence of active
bleeding and >= 11 points indicated presence of active bleeding; this
gave a sensitivity of 96%, specificity of 98%, positive predictive
value of 96% and negative predictive value of 98%.
Conclusions Simple clinical and laboratory variables available at
presentation can be used to differentiate patients with upper
gastrointestinal bleeding who do not need an early urgent upper
gastrointestinal endoscopy from those who do.
Συγγραφείς:
Adamopoulos, AB
Baibas, NM
Efstathiou, SP
Tsioulos, DI and
Mitromaras, AG
Tsami, AA
Mountokalakis, TD
Περιοδικό:
European Journal of Gastroenterology and Hepatology
Εκδότης:
Lippincott, Williams & Wilkins
Λέξεις-κλειδιά:
upper gastrointestinal bleeding; active bleeding; urgent endoscopy
DOI:
10.1097/00042737-200304000-00008
