Proposed risk stratification in upper gastrointestinal haemorrhage: is hospitalisation essential?
OBJECTIVE
Patients with upper gastrointestinal haemorrhage (UGIH) are usually admitted to hospital regardless of the severity of the bleed. The aim of this study was to identify patients who could be safely managed without hospitalisation and immediate inpatient endoscopy.


METHODS
Based on a literature review, a protocol was devised using clinical and laboratory data regarded as being of prognostic value. A retrospective observational study of consecutive patients who attended the emergency department (ED) with UGIH was conducted during one calendar month.


RESULTS
Fifty four patients were identified of whom 44 (81%) were admitted. Twelve suffered an adverse event. One of the 10 patients (10%) initially discharged from the ED was later admitted. Strict implementation of the protocol would have resulted in safe discharge of a further 15 patients, (34% of those admitted), and a saving of an estimated 37 bed days per month.


CONCLUSIONS
Patients at low risk from UGIH may be identified in the ED. If validated, this protocol may improve patient management and resource utilisation.
Courtney
A E
AE
Department of Gastroenterology, Royal Victoria Hospital, Belfast, UK.
Mitchell
R M S
RM
Rocke
L
L
Johnston
B T
BT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D004630:Emergencies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment