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Early clinical signs identify low-risk patients with acute upper gastrointestinal hemorrhage

D R Bordley, A I Mushlin, J G Dolan

    JAMA
    |June 14, 1985
    PubMed

    Insights

    This study identifies six early predictors to accurately identify patients with acute upper gastrointestinal hemorrhage who are at low risk for poor outcomes, enabling more selective management.

    Area of Science:

    • Gastroenterology
    • Internal Medicine
    • Clinical Prediction

    Background:

    • Acute upper gastrointestinal hemorrhage (AU-GIH) poses significant clinical challenges.
    • Accurate risk stratification is crucial for optimizing patient management and resource allocation.

    Purpose of the Study:

    • To develop and validate a predictive model for early identification of low-risk patients with AU-GIH.
    • To reduce unnecessary diagnostic and therapeutic interventions in low-risk patient populations.

    Main Methods:

    • Identification of six early predictors of good outcome in patients with AU-GIH.
    • Development and validation of a predictive model using retrospective and prospective study phases.
    • Key predictors included age, comorbid illness, ascites, prothrombin time, systolic blood pressure, and nasogastric aspirate findings.

    Main Results:

    • A low-risk population was defined by the presence of all six identified predictors.
    • In development and retrospective validation (162 patients), all 74 low-risk patients had good outcomes.
    • Prospective validation (111 patients) confirmed accuracy, with only 2 of 52 low-risk patients experiencing poor outcomes.

    Conclusions:

    • The developed predictive method accurately identifies low-risk patients with AU-GIH.
    • Selective management strategies can be applied to low-risk patients, potentially reducing interventions.
    • This approach facilitates more targeted and efficient care for patients with acute upper gastrointestinal bleeding.

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