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Published on: February 16, 2024
Three Simple Parameters on Admission to the Emergency Department are Predictors for Endoscopic Intervention in
Fatih Acehan1, Buket Karsavuranoğlu1, Cagdas Kalkan2
1Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
Insights
Predicting the need for endoscopic intervention in nonvariceal upper gastrointestinal bleeding (UGIB) is crucial. Syncope, mean arterial pressure (MAP), and blood urea nitrogen (BUN) at admission are key predictors, simplifying risk assessment.
Area of Science:
- Gastroenterology
- Emergency Medicine
- Clinical Prediction Models
Background:
- Nonvariceal upper gastrointestinal bleeding (UGIB) frequently necessitates endoscopic intervention.
- Accurate prediction of this need is vital for timely and appropriate patient management.
Purpose of the Study:
- To identify factors predicting the requirement for endoscopic intervention upon emergency department admission.
- To evaluate the efficacy of clinical and laboratory findings in predicting the need for endoscopic therapy.
Main Methods:
- Retrospective review of consecutive patients with gastrointestinal hemorrhage (ICD-10 code K92.2) undergoing upper endoscopy.
- Comparison of clinical and laboratory data between patients receiving endoscopic treatment and those not.
- Multivariate regression analysis to determine independent predictors of endoscopic intervention.
Main Results:
- Syncope, mean arterial pressure (MAP), and blood urea nitrogen (BUN) at admission were identified as independent predictors for endoscopic intervention.
- The combination of syncope, MAP, and BUN demonstrated predictive capability for endoscopic intervention.
- This combination showed superior prediction compared to Rockall and AIMS65 scores, but was comparable to the Glasgow-Blatchford score.
Conclusions:
- Syncope, MAP, and BUN are practical and effective predictors for endoscopic therapy in nonvariceal UGIB.
- These simple parameters offer a more accessible alternative to complex scoring systems for predicting intervention needs.
- The findings support the integration of these parameters into clinical decision-making for UGIB management.
Background:
A considerable number of patients with nonvariceal upper gastrointestinal bleeding (UGIB) need endoscopic intervention.
Objective:
The aim of this study was to determine factors that predict the need for endoscopic intervention at the time of admission to the emergency department.
Methods:
Consecutive patients with International Classification of Diseases, Tenth Revision diagnosis code K92.2 (gastrointestinal hemorrhage) who underwent upper endoscopy between February 2019 and February 2022, including patients diagnosed with nonvariceal UGIB in the emergency department in the study were reviewed retrospectively. The patients were divided into two groups: those treated endoscopically and those not treated endoscopically. These two groups were compared according to clinical and laboratory findings at admission and independent predictors for endoscopic intervention were determined using multivariate regression analysis.
Results:
Although 123 patients (30.3%) were treated endoscopically, endoscopic treatment was not required in 283 (69.7%) patients. Syncope, mean arterial pressure (MAP), and blood urea nitrogen (BUN) at admission were independent predictors for endoscopic intervention in the multivariate analysis, after adjusting for endoscopy time. The area under the curve of the syncope+MAP+BUN combination for endoscopic intervention was 0.648 (95% CI 0.588-0.708). Although the syncope+MAP+BUN combination predicted the need for intervention significantly better than pre-endoscopy Rockall and AIMS65 scores (p = 0.010 and p < 0.001, respectively), there was no significant difference in its comparison with the Glasgow-Blatchford score (p = 0.103).
Conclusions:
Syncope, MAP, and BUN at admission were independent predictors for endoscopic therapy in patients with nonvariceal UGIB. Rather than using complicated scores, it would be more practical and easier to predict the need for endoscopic intervention with these three simple parameters, which are included in the Glasgow-Blatchford score.
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