Outpatient management of upper digestive hemorrhage not associated with portal hypertension: a large prospective cohort.
OBJECTIVE
To evaluate the safety of outpatient management of upper GI hemorrhage (UGIH) not associated with portal hypertension.


METHODS
A prospective cohort of 983 subjects who went to the Accident & Emergency Department (A&ED) of a University hospital in Valencia (Spain), for UGIH not associated with portal hypertension during 1994 to 1997 were evaluated. After evaluation in the A&ED, 216 patients (22%) were discharged and referred for outpatient follow-up, but 15 patients could not be located thus, reducing the follow-up to 201 subjects. The main outcome measures were rebleeding within 10 days, emergency surgery within 15 days, and mortality for any cause during the 30 days after the initial hemorrhaging episode.


RESULTS
UGIH in subjects under outpatient care were less severe than those subjects in the hospitalized group. Hemorrhaging recurred in 7.3% of inpatients versus 0.5% of outpatients (p < 0.01); emergency surgery was required in 5.6% of the hospitalized patients and 0.5% of the outpatients (p < 0.01); a total of 20 deaths occurred in the hospitalized group (2.6%), while three (1.5%) occurred in outpatients (p = 0.26). After adjusting for several significant risk factors, outpatient management was not associated with outcomes that were worse.


CONCLUSIONS
Treatment under an outpatient regime is a safe alternative for a large percentage of selected patients with UGIH not associated with portal hypertension.
Almela
P
P
Servicio de Gastroenterología, Hospital Clinico-Universitario, Universitat de València, Spain.
Benages
A
A
Peiró
S
S
Minguez
M
M
Peña
A
A
Pascual
I
I
Mora
F
F
D000368:Aged; D000553:Ambulatory Care; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D005773:Gastroscopy; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome