Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes

a prospective study

Loren Laine, Stig B Laursen, Harry R Dalton, Jing H. Ngu, Michael Schultz, Adrian J Stanley

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND & AIMS: We performed a prospective multi-national study of patients presenting to the emergency department with upper gastrointestinal bleeding (UGIB) and assessed the relationship of time to presentation after onset of UGIB symptoms with patient characteristics and outcomes.

METHODS: Consecutive patients presenting with overt UGIB (red-blood emesis, coffee-ground emesis and/or melena) from March 2014 to March 2015 at 6 hospitals were included. Multiple pre-defined patient characteristics and outcomes were collected. Rapid presentation was defined as ≤6 hours.

RESULTS: Among 2944 patients, 1068 (36%) presented within 6 hours and 576 (20%) beyond 48 hours. Significant independent factors associated with presentation ≤6 hours versus >6 hours on logistic regression included melena (OR=0.22, 0.18-0.28), hemoglobin ≤80 g/L (OR=0.47, 0.36-0.61), altered mental status (OR=2.06, 1.55-2.73), albumin ≤30 g/L (OR=1.43, 1.14-1.78), and red-blood emesis (OR=1.29, 1.06-1.59). Patients presenting ≤6 hours versus >6 hours required transfusion less often (286 (27%) versus 791 (42%), difference = -15%, -19% to -12%) due to a smaller proportion with low hemoglobin levels, but were similar in hemostatic intervention (189 (18%) versus 371 (20%)), 30-day mortality (80 (7%) versus 121 (6%)), and hospital days (5.0±0.2 vs 5.0±0.2).

CONCLUSIONS: Patients with melena alone delay their presentation to the hospital. A delayed presentation is associated with a decreased hemoglobin and increases the likelihood of transfusion. Other outcomes are similar with rapid versus delayed presentation. Time to presentation should not be used as an indicator for poor outcome. Patients with delayed presentation should be managed with the same degree of care as those with rapid presentation.

OriginalsprogEngelsk
TidsskriftGastrointestinal Endoscopy
Vol/bind86
Udgave nummer6
Sider (fra-til)1028-1037
ISSN0016-5107
DOI
StatusUdgivet - 2017

Fingeraftryk

Prospective Studies
Melena
Coffee
Hemostatics
Hospital Emergency Service
Albumins
Logistic Models

Citer dette

Laine, Loren ; Laursen, Stig B ; Dalton, Harry R ; Ngu, Jing H. ; Schultz, Michael ; Stanley, Adrian J. / Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes : a prospective study. I: Gastrointestinal Endoscopy. 2017 ; Bind 86, Nr. 6. s. 1028-1037.
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title = "Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes: a prospective study",
abstract = "BACKGROUND & AIMS: We performed a prospective multi-national study of patients presenting to the emergency department with upper gastrointestinal bleeding (UGIB) and assessed the relationship of time to presentation after onset of UGIB symptoms with patient characteristics and outcomes.METHODS: Consecutive patients presenting with overt UGIB (red-blood emesis, coffee-ground emesis and/or melena) from March 2014 to March 2015 at 6 hospitals were included. Multiple pre-defined patient characteristics and outcomes were collected. Rapid presentation was defined as ≤6 hours.RESULTS: Among 2944 patients, 1068 (36{\%}) presented within 6 hours and 576 (20{\%}) beyond 48 hours. Significant independent factors associated with presentation ≤6 hours versus >6 hours on logistic regression included melena (OR=0.22, 0.18-0.28), hemoglobin ≤80 g/L (OR=0.47, 0.36-0.61), altered mental status (OR=2.06, 1.55-2.73), albumin ≤30 g/L (OR=1.43, 1.14-1.78), and red-blood emesis (OR=1.29, 1.06-1.59). Patients presenting ≤6 hours versus >6 hours required transfusion less often (286 (27{\%}) versus 791 (42{\%}), difference = -15{\%}, -19{\%} to -12{\%}) due to a smaller proportion with low hemoglobin levels, but were similar in hemostatic intervention (189 (18{\%}) versus 371 (20{\%})), 30-day mortality (80 (7{\%}) versus 121 (6{\%})), and hospital days (5.0±0.2 vs 5.0±0.2).CONCLUSIONS: Patients with melena alone delay their presentation to the hospital. A delayed presentation is associated with a decreased hemoglobin and increases the likelihood of transfusion. Other outcomes are similar with rapid versus delayed presentation. Time to presentation should not be used as an indicator for poor outcome. Patients with delayed presentation should be managed with the same degree of care as those with rapid presentation.",
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Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes : a prospective study. / Laine, Loren; Laursen, Stig B; Dalton, Harry R; Ngu, Jing H.; Schultz, Michael; Stanley, Adrian J.

I: Gastrointestinal Endoscopy, Bind 86, Nr. 6, 2017, s. 1028-1037.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes

T2 - a prospective study

AU - Laine, Loren

AU - Laursen, Stig B

AU - Dalton, Harry R

AU - Ngu, Jing H.

AU - Schultz, Michael

AU - Stanley, Adrian J

N1 - Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

PY - 2017

Y1 - 2017

N2 - BACKGROUND & AIMS: We performed a prospective multi-national study of patients presenting to the emergency department with upper gastrointestinal bleeding (UGIB) and assessed the relationship of time to presentation after onset of UGIB symptoms with patient characteristics and outcomes.METHODS: Consecutive patients presenting with overt UGIB (red-blood emesis, coffee-ground emesis and/or melena) from March 2014 to March 2015 at 6 hospitals were included. Multiple pre-defined patient characteristics and outcomes were collected. Rapid presentation was defined as ≤6 hours.RESULTS: Among 2944 patients, 1068 (36%) presented within 6 hours and 576 (20%) beyond 48 hours. Significant independent factors associated with presentation ≤6 hours versus >6 hours on logistic regression included melena (OR=0.22, 0.18-0.28), hemoglobin ≤80 g/L (OR=0.47, 0.36-0.61), altered mental status (OR=2.06, 1.55-2.73), albumin ≤30 g/L (OR=1.43, 1.14-1.78), and red-blood emesis (OR=1.29, 1.06-1.59). Patients presenting ≤6 hours versus >6 hours required transfusion less often (286 (27%) versus 791 (42%), difference = -15%, -19% to -12%) due to a smaller proportion with low hemoglobin levels, but were similar in hemostatic intervention (189 (18%) versus 371 (20%)), 30-day mortality (80 (7%) versus 121 (6%)), and hospital days (5.0±0.2 vs 5.0±0.2).CONCLUSIONS: Patients with melena alone delay their presentation to the hospital. A delayed presentation is associated with a decreased hemoglobin and increases the likelihood of transfusion. Other outcomes are similar with rapid versus delayed presentation. Time to presentation should not be used as an indicator for poor outcome. Patients with delayed presentation should be managed with the same degree of care as those with rapid presentation.

AB - BACKGROUND & AIMS: We performed a prospective multi-national study of patients presenting to the emergency department with upper gastrointestinal bleeding (UGIB) and assessed the relationship of time to presentation after onset of UGIB symptoms with patient characteristics and outcomes.METHODS: Consecutive patients presenting with overt UGIB (red-blood emesis, coffee-ground emesis and/or melena) from March 2014 to March 2015 at 6 hospitals were included. Multiple pre-defined patient characteristics and outcomes were collected. Rapid presentation was defined as ≤6 hours.RESULTS: Among 2944 patients, 1068 (36%) presented within 6 hours and 576 (20%) beyond 48 hours. Significant independent factors associated with presentation ≤6 hours versus >6 hours on logistic regression included melena (OR=0.22, 0.18-0.28), hemoglobin ≤80 g/L (OR=0.47, 0.36-0.61), altered mental status (OR=2.06, 1.55-2.73), albumin ≤30 g/L (OR=1.43, 1.14-1.78), and red-blood emesis (OR=1.29, 1.06-1.59). Patients presenting ≤6 hours versus >6 hours required transfusion less often (286 (27%) versus 791 (42%), difference = -15%, -19% to -12%) due to a smaller proportion with low hemoglobin levels, but were similar in hemostatic intervention (189 (18%) versus 371 (20%)), 30-day mortality (80 (7%) versus 121 (6%)), and hospital days (5.0±0.2 vs 5.0±0.2).CONCLUSIONS: Patients with melena alone delay their presentation to the hospital. A delayed presentation is associated with a decreased hemoglobin and increases the likelihood of transfusion. Other outcomes are similar with rapid versus delayed presentation. Time to presentation should not be used as an indicator for poor outcome. Patients with delayed presentation should be managed with the same degree of care as those with rapid presentation.

KW - Journal Article

U2 - 10.1016/j.gie.2017.03.1549

DO - 10.1016/j.gie.2017.03.1549

M3 - Journal article

VL - 86

SP - 1028

EP - 1037

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 6

ER -