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Observational Study
. 2017 Aug 14;25(1):78.
doi: 10.1186/s13049-017-0425-6.

Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study

Pierre-Clément Thiebaud  1   2 , Youri Yordanov  1   3   4 , Jacques-Emmanuel Galimard  5 , Pierre-Alexis Raynal  1   3 , Sébastien Beaune  2   6 , Laurent Jacquin  2   7 , François-Xavier Ageron  2   8 , Dominique Pateron  9   10 ; Initiatives de Recherche aux Urgences Group
Affiliations
Observational Study

Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study

Pierre-Clément Thiebaud et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Upper gastrointestinal bleeding (UGB) is common in emergency departments (EDs) and can be caused by many eso-gastro-duodenal lesions. Most available epidemiological data and data on the management of UGB comes from specialized departments (intensive care units or gastroenterology departments), but little is known from the ED perspective. We aimed to determine the distribution of symptoms revealing UGB in EDs and the hemorrhagic lesions identified by endoscopy. We also describe the characteristics of patients consulting for UGB, UGB management in the ED and patients outcomes.

Method: This was a prospective, observational, multicenter study covering 4 consecutive days in November 2013. Participating EDs were part of the Initiatives de Recherche aux Urgences network coordinated by the French Society of Emergency Medicine. All patients with suspected UGB in these EDs were included.

Results: In total, 110 EDs participated, including 194 patients with suspected UGB (median age 66 years [Q1-Q3: 51-81]). Overall, 104 patients (54%) had hematemesis and 75 (39%) melena. Endoscopy revealed lesions in 121 patients, mainly gastroduodenal ulcer or ulcerations (41%) or bleeding lesions due to portal hypertension (20%). The final diagnosis of UGB was reversed by endoscopy in only 3% of cases. Overall, 67 patients (35%) had at least one severity sign. Twenty-one patients died (11%); 40 (21%) were hospitalized in intensive care units and 126 (65%) in medicine departments; 28 (14%) were outpatients. Mortality was higher among patients with clinical and biological severity signs.

Conclusion: Most of the UGB cases in EDs are revealed by hematemesis. The emergency physician diagnosis of UGB is rarely challenged by the endoscopic findings.

Keywords: Emergency department; Endoscopy; Gastrointestinal bleeding; Hematemesis; Melena.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the institutional review board (IRB) (Comité de protection des personnes, Ile de France XI, Paris, France) and the Advisory Committee on Information Processing in Material Research in the Field of Health (CCTIRS). Patients, or their next of kin, were informed that a study was being led and that their data might be used. They could refuse being included.

Consent for publication

Not applicable.

Competing interests

The authors declare no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow of patients from the first symptoms of suspected upper gastrointestinal bleeding (UGB) to endoscopy diagnosis. N = total number of patients. n1 = patients arriving to the emergency department. n2 = patients initially assessed by a pre-hospital medical team
See this image and copyright information in PMC

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