K Y Tham1, H Kimura, T Nagurney, F Volinsky. 1. Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Republic of Singapore. kum_ying_tham@notes.ttsh.gov.sg
Abstract
OBJECTIVE: To determine the number of ED patients with non-variceal upper gastrointestinal hemorrhage (NVUGIH) who could have been managed as outpatients through application of previously developed clinical guidelines. METHOD: Descriptive study based on retrospective chart review of patients who presented with acute upper gastrointestinal hemorrhage (UGIH) to the ED of an urban teaching hospital from July 1 to December 31, 1996. Applying the clinical guidelines published by a health maintenance organization (HMO) group (no high-risk endoscopic features/varices/portal hypertensive gastropathy, no debilitation, no orthostatic vital sign change, no severe liver disease, no serious concomitant disease, no anticoagulation or coagulopathy, no fresh, voluminous hematemesis or multiple episodes of melena on the day of presentation, no severe anemia, and adequate home support), patients who could have been managed as outpatients after esophagogastroduodenoscopy (EGD) were identified and analyzed. RESULTS: 145 UGIH patients were seen in the ED, of whom 128 (88%) were admitted and 111 (77%) underwent EGD. 21 (19%) had varices, leaving 90 (81%) with NVUGIH. 18 of these 90 patients (20%, 95% CI = 12% to 28%) fulfilled guidelines for outpatient management and had the following characteristics with p < 0.05: younger age [mean 54.2+/-5.5 (SEM) vs 63.8+/-1.9 years], less transfusion (0.9+/-0.3 vs 3.7+/-0.4 units), and shorter length of stay (2.1+/-0.4 vs 5.3+/-0.7 days). None of the 18 outpatient management patients had any complications. CONCLUSION: In a non-HMO urban teaching hospital, 18 patients with NVUGIH met criteria for outpatient management in a six-month period and none developed a complication during a mean in-hospital stay of 2.1 days.
OBJECTIVE: To determine the number of ED patients with non-variceal upper gastrointestinal hemorrhage (NVUGIH) who could have been managed as outpatients through application of previously developed clinical guidelines. METHOD: Descriptive study based on retrospective chart review of patients who presented with acute upper gastrointestinal hemorrhage (UGIH) to the ED of an urban teaching hospital from July 1 to December 31, 1996. Applying the clinical guidelines published by a health maintenance organization (HMO) group (no high-risk endoscopic features/varices/portal hypertensive gastropathy, no debilitation, no orthostatic vital sign change, no severe liver disease, no serious concomitant disease, no anticoagulation or coagulopathy, no fresh, voluminous hematemesis or multiple episodes of melena on the day of presentation, no severe anemia, and adequate home support), patients who could have been managed as outpatients after esophagogastroduodenoscopy (EGD) were identified and analyzed. RESULTS: 145 UGIH patients were seen in the ED, of whom 128 (88%) were admitted and 111 (77%) underwent EGD. 21 (19%) had varices, leaving 90 (81%) with NVUGIH. 18 of these 90 patients (20%, 95% CI = 12% to 28%) fulfilled guidelines for outpatient management and had the following characteristics with p < 0.05: younger age [mean 54.2+/-5.5 (SEM) vs 63.8+/-1.9 years], less transfusion (0.9+/-0.3 vs 3.7+/-0.4 units), and shorter length of stay (2.1+/-0.4 vs 5.3+/-0.7 days). None of the 18 outpatient management patients had any complications. CONCLUSION: In a non-HMO urban teaching hospital, 18 patients with NVUGIH met criteria for outpatient management in a six-month period and none developed a complication during a mean in-hospital stay of 2.1 days.