title: The management of low-risk primary upper gastrointestinal haemorrhage in the community:  a 5-year observational study.
abstract: BACKGROUND
  Acute upper gastrointestinal haemorrhage is a common medical emergency, initially managed with inpatient care. Bleeding stops spontaneously in over 80% of cases, indicating that patients with low-risk upper gastrointestinal haemorrhage may be more optimally managed in the community, without the need for admission to hospital.
  
  
  OBJECTIVE
  To assess the safety of managing patients with low-risk upper gastrointestinal haemorrhage without admission to hospital.
  
  
  METHODS
  Prospective/retrospective study of all patients presenting to a UK teaching hospital with low-risk upper gastrointestinal haemorrhage who were managed without admission to hospital over 5 years. Low risk was defined as Glasgow Blatchford Score of 2 or less, age below 70 years, no other active medical problems, not taking warfarin and suspected nonvariceal bleed. Outcome measures were the need for intervention (blood transfusion, endoscopic therapy or surgery) and death.
  
  
  RESULTS
  One hundred and forty-two patients fulfilled the inclusion criteria, and were managed without admission to hospital. No patients required endoscopic intervention, blood transfusion or surgery. The 28-day mortality was nil. Forty-one patients had normal endoscopic examination and 11 had significant endoscopic findings (peptic ulceration=10, oozing Mallory-Weiss tear=1) but did not require intervention.
  
  
  CONCLUSIONS
  Patients presenting with a primary upper gastrointestinal haemorrhage aged below 70 years with a Glasgow Blatchford Score of 2 or less are at a low risk, and can be safely managed in the community.
authors.affiliation: Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth, Truro, Cornwall, UK.
authors.forename: Cara
authors.initials: C
authors.lastname: McLaughlin
authors.forename: Louisa
authors.initials: L
authors.lastname: Vine
authors.forename: Luke
authors.initials: L
authors.lastname: Chapman
authors.forename: Paula
authors.initials: P
authors.lastname: Deering
authors.forename: Sam
authors.initials: S
authors.lastname: Whittaker
authors.forename: John
authors.initials: J
authors.lastname: Beckly
authors.forename: Paul
authors.initials: P
authors.lastname: Fortun
authors.forename: Iain A
authors.initials: IA
authors.lastname: Murray
authors.forename: S Hyder
authors.initials: SH
authors.lastname: Hussaini
authors.forename: Nick P
authors.initials: NP
authors.lastname: Michell
authors.forename: Bill
authors.initials: B
authors.lastname: Stableforth
authors.forename: Peter
authors.initials: P
authors.lastname: Thatcher
authors.forename: Nicola C
authors.initials: NC
authors.lastname: Hare
authors.forename: Jo
authors.initials: J
authors.lastname: Palmer
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003153:Community Health Services / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D004739:England; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management; D057240:Patient Preference; D010437:Peptic Ulcer / Q000150:complications / Q000175:diagnosis; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D014508:Urea / Q000097:blood
chemical_list: D006454:Hemoglobins; D014508:Urea