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Predicting poor outcome from acute upper gastrointestinal hemorrhage.
Thomas F Imperiale1, Jason A Dominitz, Dawn T Provenzale
1Department of Medicine, Roudebush Veterans Affairs Medical Center, The Center of Excellence on Implementing Evidence-Based Practice, Indiana University School of Medicine, Indianapolis 46202, USA.
Archives of Internal Medicine
|June 27, 2007
Summary
Clinical prediction rules (CPRs) can identify low-risk patients with acute upper gastrointestinal bleeding. These rules help shorten hospital stays by enabling early discharge for patients without identified risk factors.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Health Services Research
Background:
- Acute upper gastrointestinal bleeding (UGIB) often leads to prolonged hospitalizations due to outcome uncertainty.
- Developing tools to accurately predict UGIB outcomes is crucial for optimizing patient management and resource allocation.
Purpose of the Study:
- To derive and validate clinical prediction rules (CPRs) for predicting poor outcomes in patients with acute upper gastrointestinal bleeding.
- To identify patients eligible for earlier hospital discharge, thereby improving hospital management efficiency.
Main Methods:
- A multisite, prospective cohort study enrolled 391 patients with acute upper gastrointestinal bleeding.
- Multivariate logistic regression was used to derive CPRs predicting bleeding-specific outcomes or outcomes including comorbidity.
- The derived CPRs were internally validated on a separate cohort subset.
Main Results:
- Independent predictors for poor outcomes included APACHE II score ≥ 11, esophageal varices, and stigmata of recent hemorrhage.
- Patients with no identified risk factors had a low incidence of poor outcomes (1.1% for outcome 1, 6.2% for outcome 2).
- The CPRs identified approximately 32-38% of patients as eligible for a shorter hospital stay.
Conclusions:
- Absence of specific risk factors indicates a low likelihood of poor outcomes in acute upper gastrointestinal bleeding.
- These validated CPRs can enhance hospital efficiency by identifying low-risk patients suitable for early discharge.
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