title: ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis.
abstract: OBJECTIVE
  In patients with gastrointestinal (GI) tract bleeding, the bleeding source is uncertain in the absence of hematemesis. We sought to identify clinical variables predictive of an upper GI bleeding source.
  
  
  METHODS
  This retrospective cohort study involved patients admitted via the ED for GI tract bleeding without hematemesis, who underwent confirmatory testing. We used logistic regression analysis to identify clinical variables independently associated with an upper GI source.
  
  
  RESULTS
  Among 325 patients, odds ratios for the strongest predictors were as follows: black stool, 16.6 (95% confidence interval [CI], 7.7-35.7); age less than 50 years, 8.4 (95% CI, 3.2-22.1); and blood urea nitrogen/creatinine ratio 30 or greater, 10.0 (95% CI, 4.0-25.6). Seven (5%) of 151 with none of these factors had an upper GI tract bleed, versus 63 (93%) of 68 with 2 or 3 factors.
  
  
  CONCLUSIONS
  Black stool, age less than 50 years, and blood urea nitrogen/creatinine ratio of 30 or greater independently predict an upper GI tract bleeding source.
authors.affiliation: Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Witting
authors.forename: Laurence
authors.initials: L
authors.lastname: Magder
authors.forename: Alan E
authors.initials: AE
authors.lastname: Heins
authors.forename: Amal
authors.initials: A
authors.lastname: Mattu
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Granja
authors.forename: Mona
authors.initials: M
authors.lastname: Baumgarten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006396:Hematemesis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors