When to discharge patients with bleeding peptic ulcers: a prospective study of residual risk of rebleeding.
BACKGROUND
From January 1993 to December 1994, we conducted a prospective study to investigate the evolutionary change of rebleeding risk in bleeding peptic ulcers. To obviate possible confounding factors that would influence decision making for discharge of patients, subjects with coexistent acute illnesses, systemic bleeding disorders, alcoholism, and use of nonsteroidal anti-inflammatory drugs were excluded.


METHODS
Emergency endoscopies were performed in patients with hematemesis or a melena within 24 hours of admission. Ulcer lesions were divided into six categories according to endoscopic findings. The residual risks of rebleeding of each type of ulcers were calculated for 10 days, and the critical point of acceptable rebleeding risk after discharge was set at 3%.


RESULTS
Three hundred ninety-two patients with bleeding peptic ulcers completed the study. The ulcers, characterized by clean bases, red or black spots, adherent clots, nonbleeding visible vessels without local therapy, nonbleeding visible vessels with local therapy, and bleeding visible vessels with local therapy took 0, 3, 3, 4, 4, and 3 days, respectively, to decrease rebleeding risk to below the critical point. All episodes of fatal rebleeding (n = 4) occurred within 24 hours after admission.


CONCLUSIONS
Patients with clean-based ulcers can be discharged in the first day of admission. The optimal duration required for hospitalization of patients with ulcers characterized by nonbleeding visible vessels at initial endoscopy is 4 days. The remaining patients with ulcers marked by other bleeding stigmata may be discharged after a 3-day observation.
Hsu
P I
PI
Department of Emergency, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C.
Lai
K H
KH
Lin
X Z
XZ
Yang
Y F
YF
Lin
M
M
Shin
J S
JS
Lo
G H
GH
Huang
R L
RL
Chang
C F
CF
Lin
C K
CK
Ger
L P
LP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000503:physiopathology; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors