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Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study
- Source :
- Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, BioMed Central, 2016, 25 (1), pp.78. ⟨10.1186/s13049-017-0425-6⟩, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 25, Iss 1, Pp 1-9 (2017), Scandinavian journal of trauma, resuscitation and emergency medicine, vol. 25, no. 1, pp. 78, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, BioMed Central, 2016, 25 (1), pp.78. 〈10.1186/s13049-017-0425-6〉, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2016, 25 (1), pp.78. ⟨10.1186/s13049-017-0425-6⟩
- Publication Year :
- 2016
- Publisher :
- HAL CCSD, 2016.
-
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. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0425-6) contains supplementary material, which is available to authorized users.
- Subjects :
- Adult
Male
medicine.medical_specialty
Gastrointestinal bleeding
[SDV]Life Sciences [q-bio]
Critical Care and Intensive Care Medicine
03 medical and health sciences
0302 clinical medicine
Melena
Intensive care
Epidemiology
medicine
Humans
030212 general & internal medicine
Prospective Studies
Original Research
Aged
Aged, 80 and over
[ SDV ] Life Sciences [q-bio]
medicine.diagnostic_test
business.industry
Emergency department
lcsh:Medical emergencies. Critical care. Intensive care. First aid
Emergency Service, Hospital
Endoscopy
Female
France
Gastrointestinal Hemorrhage/diagnosis
Gastrointestinal Hemorrhage/etiology
Gastrointestinal Hemorrhage/therapy
Middle Aged
Symptom Assessment
Hematemesis
lcsh:RC86-88.9
medicine.disease
3. Good health
[SDV] Life Sciences [q-bio]
Emergency medicine
Emergency Medicine
Portal hypertension
030211 gastroenterology & hepatology
Upper gastrointestinal bleeding
medicine.symptom
business
Gastrointestinal Hemorrhage
Subjects
Details
- Language :
- English
- ISSN :
- 17577241
- Database :
- OpenAIRE
- Journal :
- Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, BioMed Central, 2016, 25 (1), pp.78. ⟨10.1186/s13049-017-0425-6⟩, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 25, Iss 1, Pp 1-9 (2017), Scandinavian journal of trauma, resuscitation and emergency medicine, vol. 25, no. 1, pp. 78, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, BioMed Central, 2016, 25 (1), pp.78. 〈10.1186/s13049-017-0425-6〉, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2016, 25 (1), pp.78. ⟨10.1186/s13049-017-0425-6⟩
- Accession number :
- edsair.doi.dedup.....ece5b4f8a5ba5a7eb5948be67884d496