342 THE IMPACT OF NIGHT-TIME EMERGENCY DEPARTMENT PRESENTATION ON UPPER GASTROINTESTINAL BLEEDING OUTCOMES

Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

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Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study

PeerJ ◽

10.7717/peerj.11656 ◽

2021 ◽

Vol 9 ◽

pp. e11656

Author(s):

Lan Chen ◽

Han Zheng ◽

Saibin Wang

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Area Under The Curve ◽

Decision Curve Analysis ◽

Acute Upper Gastrointestinal Bleeding ◽

Bleeding Score ◽

Selection Operator ◽

Upper Gastrointestinal ◽

D Dimer

Background Upper gastrointestinal bleeding is a common presentation in emergency departments and carries significant morbidity worldwide. It is paramount that treating physicians have access to tools that can effectively evaluate the patient risk, allowing quick and effective treatments to ultimately improve their prognosis. This study aims to establish a mortality risk assessment model for patients with acute upper gastrointestinal bleeding at an emergency department. Methods A total of 991 patients presenting with acute upper gastrointestinal bleeding between July 2016 and June 2019 were enrolled in this retrospective single-center cohort study. Patient demographics, parameters assessed at admission, laboratory test, and clinical interventions were extracted. We used the least absolute shrinkage and selection operator regression to identify predictors for establishing a nomogram for death in the emergency department or within 24 h after leaving the emergency department and a corresponding nomogram. The area under the curve of the model was calculated. A bootstrap resampling method was used to internal validation, and decision curve analysis was applied for evaluate the clinical utility of the model. We also compared our predictive model with other prognostic models, such as AIMS65, Glasgow-Blatchford bleeding score, modified Glasgow-Blatchford bleeding score, and Pre-Endoscopic Rockall Score. Results Among 991 patients, 41 (4.14%) died in the emergency department or within 24 h after leaving the emergency department. Five non-zero coefficient variables (transfusion of plasma, D-dimer, albumin, potassium, age) were filtered by the least absolute shrinkage and selection operator regression analysis and used to establish a predictive model. The area under the curve for the model was 0.847 (95% confidence interval [0.794–0.900]), which is higher than that of previous models for mortality of patients with acute upper gastrointestinal bleeding. The decision curve analysis indicated the clinical usefulness of the model. Conclusions The nomogram based on transfusion of plasma, D-dimer, albumin, potassium, and age effectively assessed the prognosis of patients with acute upper gastrointestinal bleeding presenting at the emergency department.

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Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918783159 ◽

2018 ◽

Vol 26 (1) ◽

pp. 31-38

Author(s):

Zeynep Konyar ◽

Ozlem Guneysel ◽

Fatma Sari Dogan ◽

Eren Gokdag

Keyword(s):

Emergency Department ◽

Blood Transfusion ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Venous Blood ◽

Erythrocyte Suspension ◽

Laboratory Findings ◽

Significant Difference ◽

Lactate Levels ◽

Upper Gastrointestinal

Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient’s emergency visit. Objective: The purpose of this study is to investigate the efficacy of “Glasgow-Blatchford scale + lactate levels” to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department. Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated. Results: A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p < 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(–) GBS(+), lactate(+) GBS(–), and lactate(–) GBS(–) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p < 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p < 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above. Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish “modified Glasgow-Blatchford scale.” In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.

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Comparison of risk scores and shock index in hemodynamically stable patients presenting to the emergency department with nonvariceal upper gastrointestinal bleeding

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000001422 ◽

2019 ◽

Vol 31 (7) ◽

pp. 781-785 ◽

Cited By ~ 1

Author(s):

Dae Ho Jung ◽

Byuk Sung Ko ◽

Youn-Jung Kim ◽

Won Young Kim

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Risk Scores ◽

Shock Index ◽

Upper Gastrointestinal

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Prospective validation of the Glasgow Blatchford scoring system in patients with upper gastrointestinal bleeding in the emergency department

The Turkish Journal of Gastroenterology ◽

10.4318/tjg.2012.0385 ◽

2012 ◽

Vol 23 (5) ◽

pp. 448-455 ◽

Cited By ~ 6

Author(s):

Ozlem KOKSAL ◽

Gulden OZEREN ◽

Fatma OZDEMIR ◽

Erol ARMAGAN ◽

Sule AYDIN ◽

...

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Scoring System ◽

Upper Gastrointestinal Bleeding ◽

Upper Gastrointestinal

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Impact of the COVID-19 Pandemic on Acute Upper Gastrointestinal Bleeding in Xingtai City

Gastroenterology Research and Practice ◽

10.1155/2021/5586030 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Zhihui Duan ◽

Qiong Duan ◽

Kun Liu ◽

Xiaochong Zhang ◽

Shengyun Zhou ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Gastrointestinal Endoscopy ◽

Upper Gastrointestinal Bleeding ◽

Daily Practice ◽

Absolute Number ◽

Web Based ◽

Acute Upper Gastrointestinal Bleeding ◽

Before And After ◽

The Impact ◽

Upper Gastrointestinal

Background and Aims. The coronavirus disease 2019 (COVID-19) has severely impacted the daily practice of gastrointestinal endoscopy worldwide. Most endoscopy centers in China were shut down in late January 2020. We investigated the impact of the shutdown on acute upper gastrointestinal bleeding (AUGIB) events in Xingtai City, Hebei Province, China. Methods. A web-based survey collected information on gastroscopy workload and AUGIB events. The study period was from 4 weeks before to 4 weeks after lockdown initiation in Xingtai City. Fourteen public gastrointestinal endoscopy centers performing emergency endoscopies were contacted via e-mail to collect weekly emergency gastroscopy volumes and the number of AUGIB events. AUGIB was defined as recent melena, hematemesis, or both, with an endoscopically visible source of bleeding. Results. Twelve (85.7%) of the 14 surveyed gastrointestinal endoscopy centers in the city- and county-level hospitals responded. Altogether, 4,045 and 1,077 gastroscopy procedures were performed 4 weeks before and after lockdown initiation (73.4% reduction), respectively. Peptic ulcer-related AUGIB and variceal AUGIB events showed a 58.5% and 52.9% decline, respectively, compared with pre-COVID-19 data. Although the absolute number of AUGIB events decreased during the pandemic (from 149 to 66), the likelihood of detecting AUGIB during gastroscopy increased (3.68% (pre-COVID-19 period) versus 6.13% (COVID-19 period); P < 0.05 ). Conclusion. The COVID-19 pandemic resulted in a considerable reduction in gastroscopy workload and AUGIB events; however, the likelihood of detecting AUGIB increased significantly during gastroscopies.

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