P086: Emergency department visits for upper gastrointestinal bleeding: a population-based Alberta cohort

Introduction: Upper gastrointestinal bleeding (UGIB) is a common medical condition presenting to emergency departments (ED) and associated with substantial morbidity, mortality, and healthcare expenditures. Our aim was to evaluate the incidence of patients presenting to ED with UGIB in a large population-based surveillance cohort. Methods: The National Ambulatory Care Reporting System (NACRS) was used to identify all presentations to emergency departments for UGIB in Alberta from fiscal year 2010 to 2015 (n=56519) using the International Classification of Diseases Codes (ICD-10) in any diagnostic position. Baseline characteristics and UGIB incidence were calculated using descriptive statistics. Joinpoint regression models were used to calculate the average annual percent change (AAPC) with 95% confidence intervals (CI). Results: The median age of 56519 UGIB presentations was 56 years (interquartile range: 41 to 74 years), 56% were male, and 245% had at least one comorbidity. At time of disposition from the ED , 48.3% were admitted to or transferred to another hospital, 51.4% discharged, and 0.3% died in the emergency department. Further, 10.8% underwent upper endoscopy during their admission to the emergency department. The annual incidence of UGIB were 230.6 (2010), 232.8 (2011), 241.0 (2012), 242.2 (2013), 244.6 (2014), and 242.2 (2015) per 100,000 person-years. Between 2010 and 2015 the incidence of UGIB presenting to ED significantly increased overtime (AAPC=1.1; 95% CI: 0.3 to 2.0). Conclusion: UGIB is a common presentation to emergency departments and has been increasing overtime. Future studies are necessary to evaluate the underlying cause of UGIB and to determine its burden to Albertas healthcare system.

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Long‐term risk of upper gastrointestinal bleeding after Helicobacter pylori eradication: a population‐based cohort study

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.16604 ◽

2021 ◽

Author(s):

Fang Jiang ◽

Chuan‐Guo Guo ◽

Ka Shing Cheung ◽

Wai K. Leung

Keyword(s):

Helicobacter Pylori ◽

Cohort Study ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Population Based ◽

Helicobacter Pylori Eradication ◽

Upper Gastrointestinal

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Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v8i2.28839 ◽

2021 ◽

Vol 8 (2) ◽

pp. 105-111

Author(s):

Sunil Adhikari ◽

Suraj Rijal ◽

Darlene Rose House

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Variceal Bleeding ◽

Clinical Presentation ◽

Upper Gastrointestinal Bleeding ◽

Tertiary Hospital ◽

Clinical Profile ◽

Ulcer Bleeding ◽

Cross Sectional ◽

Upper Gastrointestinal

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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