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

PeerJ ◽  
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.

scholarly journals Modified Glasgow-Blatchford Bleeding Score as an Alternative Predictors of Severity for Non-Variceal Upper Gastrointestinal Bleeding

2016 ◽  
Vol 8 (2) ◽  
pp. 91
Author(s):  
Taufiq Abdullah ◽  
Siswanto Siswanto ◽  
Bogi Pratomo
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Operating Characteristic ◽  
Hospital Admissions ◽  
Upper Gastrointestinal Bleeding ◽  
Scoring Systems ◽  
Risk Scoring ◽  
Bleeding Score ◽  
Upper Gastrointestinal

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a frequent cause of emergency hospital admissions. Despite the dependency of most risk scoring systems for this disorder, the Glasgow-Blatchford bleeding score (GBS) is based on simple variables. This research intended for investigate the accuracy of a modified GBS (mGBS) to predict the severity of non-variceal UGIB.METHODS: Study conducted in Emergency Department of Dr. Saiful Anwar Hospital, Malang, from November 2012 to April 2013. Endoscopy performed between 12-24 hours after the patient stabilized. Sixty patients diagnosed were included. The accuracy of the mGBS in predicting the severity of non-variceal UGIB was compared with the full GBS using receiver operating characteristic (ROC) curve. The severity based on high risk in mGBS score compared by Forrest classification.RESULTS: For prediction of the severity of non-variceal UGIB, the GBS (AUC 0.947, 95% CI 0.87-1.03) had a slightly than the mGBS (AUC 0.943, 95% CI 0.86-1.02, p<0.01). Compared to the GBS, the mGBS was more specific (63% and 97%, respectively) but less sensitive (96% and 84%, respectively).CONCLUSION: The mGBS is an alternative diagnostic tool in predicting the severity of non-variceal UGIB.KEYWORDS: non variceal-UGIB, GBS, modified GBS

scholarly journals Mo1263 – Acute Upper Gastrointestinal Bleeding: Evaluating Physician Practices in the Emergency Department

2019 ◽  
Vol 156 (6) ◽  
pp. S-738-S-739
Author(s):  
Jesse Stach ◽  
Simrat Sandha ◽  
Michael Bullard ◽  
Brendan P. Halloran ◽  
Heather Blain ◽  
...  
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Physician Practices ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

scholarly journals Role of Urgent Endoscopy in Patients With Suspected Upper Gastrointestinal Bleeding

2021 ◽  
Author(s):  
Jeemyoung Kim ◽  
Eun Jeong Gong ◽  
Myeongsook Seo ◽  
Jong Kyu Park ◽  
Sang Jin Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mortality Rate ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Manifestations ◽  
Length Of Hospital Stay ◽  
Optimal Timing ◽  
Recurrent Bleeding ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

Abstract The optimal timing of endoscopy in patients with acute upper gastrointestinal bleeding (UGIB) remains controversial. In this study, we investigated the clinical outcomes of urgent endoscopy in patients with symptoms suggestive of UGIB compared with elective endoscopy.From January 2016 to December 2018, consecutive patients who visited the emergency department and underwent endoscopy for clinical manifestations of acute UGIB were eligible. Urgent endoscopy (within 6 hours) and elective endoscopy (after 6 hours) were defined as the time taken to perform endoscopy from presentation to the emergency department. The primary outcome was mortality rate within 30 days.A total of 572 patients were included in the analysis. Urgent endoscopy was performed in 490 patient. The 30–day mortality rate did not differ between the urgent endoscopy group and the elective endoscopy group. There was no difference regarding the recurrent bleeding rate, total amount of transfusion, and length of hospital stay in both groups. In multivariate analysis, age and the amount of transfusion were factors associated with mortality.Urgent endoscopy was not associated with lower 30–day mortality rate compared with elective endoscopy in patients with suspected of acute UGIB.

scholarly journals Are AIMS65 and glasgow-blatchford scores useful in predicting health costs in patients admitted to emergency department with acute upper gastrointestinal bleeding: a prospective and observational study

2021 ◽  
Vol 38 (3) ◽  
pp. 326-330
Author(s):  
Hayrullah YÖNAK ◽  
Serdar ÖZDEMİR ◽  
Kamil KOKULU ◽  
Hatice Şeyma AKÇA ◽  
Mehmet Muzaffer İSLAM ◽  
...  
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Risk Group ◽  
Statistical Significance ◽  
High Risk Group ◽  
Health Costs ◽  
Chi Square ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal

We aimed to investigate the use and superiority of AIMS65 (Albumin, INR, Alteration in mental status, Systolic blood pressure, age) and Glasgow-Blatchford scores (GBS) in predicting hospital health costs in patients admitted to emergency department with upper gastrointestinal bleeding. Patients above the age of 18 who were admitted to the Emergency Department of Ümraniye Training and Research Hospital between 01.06.2018 and 31.05.2019, who were diagnosed with upper gastrointestinal bleeding were included in the study. Patients’ calculations of AIMS65 and GBS were recorded. Pearson’s Chi-square test was used, and statistical significance was assessed. A total of 151 patients included in the study, 109 (72.2%) were male. Of the patients 2(1.3%) were discharged from the emergency department and 7 (4.6%) were exitus. According to AIMS65 risk scoring, costs of emergency department and inpatient clinics and total clinical costs were higher in high risk group compared to the low risk group (p=0.007, p=0.007 and p=0.003 respectively). The costs of emergency department and inpatient clinic and total costs were found statistically significantly different between GBS groups (p<0.001, p=0.019, and p=0.001 respectively). AIMS65 risk score and GBS have been revealed to be useful in predicting the costs of emergency department and inpatient clinics and total clinical costs for patients with upper gastrointestinal bleeding.

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