Clinical predictors of bleeding esophageal varices in the ED.
OBJECTIVE
Some authors have found that thrombocytopenia (<118,000/mm3), splenomegaly, and ascites are useful predictors of large esophageal varices in cirrhotic patients. We decide to see whether these factors could also be used to predict bleeding esophageal varices in patients known to have chronic liver disease in the ED.


METHODS
A case record review was done of all patients admitted to the ED of Changi General Hospital with upper gastrointestinal bleeding from esophageal varices from October 1999 to April 2004. The criteria of thrombocytopenia, splenomegaly, and ascites were applied retrospectively to these patients to see how accurately they performed in predicting bleeding esophageal varices.


RESULTS
Only 55% of patients had thrombocytopenia, whereas 45% had splenomegaly, and 27.5% had ascites. Combining thrombocytopenia with the presence of either ascites or splenomegaly did not improve the yield (only 40%), and only 6 patients had all 3 criteria. Twelve patients with bleeding varices did not have any of the criteria.


CONCLUSIONS
Thrombocytopenia, splenomegaly, or ascites is an unreliable predictor of bleeding esophageal varices. Urgent or emergent endoscopy is still advocated to accurately diagnose bleeding esophageal varices.
Goh
Siang-Hiong
SH
Accident and Emergency Department, Changi General Hospital, Singapore, Republic of Singapore. cghgsh@pacific.net.sg
Tan
Wee-Ping
WP
Lee
Shu-Woan
SW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D012307:Risk Factors; D012846:Singapore; D013163:Splenomegaly / Q000175:diagnosis / Q000453:epidemiology; D013921:Thrombocytopenia / Q000097:blood / Q000453:epidemiology