title: Can pre-endoscopic assessment predict active upper gastrointestinal bleeding? A retrospective study in patients with symptoms of upper gastrointestinal bleeding outside regular working hours.
abstract: OBJECTIVE
  To evaluate the usefulness of pre-endoscopic assessment for predicting active up-per gastrointestinal bleeding (UGI-B) at emergency esophagogastroduodenoscopy (E-EGD, within 6 hours).
  
  
  METHODS
  We retrospectively analysed the medical records of patients that had an E-EGD performed outside working hours and considered 15 pre-endoscopic variables in a univariate analysis. Active UGI-Bat E-EGD was taken as end-point.
  
  
  RESULTS
  Of 228 E-EGD performed during 75 months, 195 were motivated by the suspicion of UGI-B. We excluded 83 cases as they were hospitalised at the time of first symptoms of bleeding. Thus, 112 cases were included. The following clinical signs triggered E-EGD: hematemesis (56/50%),melena (55/49.1%), hematochezia (20/17.8%), anae- mia (7/6.2%). Patients' age was 65.5+14.2 years. Sixty nine (61.6%) cases were male. The relative risk and p-value of the variables for the presence of active bleeding at E-EGD were as follows: hematemesis: 1.54/0.3; malignancy and cirrhosis: 1.73/0.07; haemoglobin <8g/dL: 1.38/0.3; white blood count >12,000/tL: 1.18/0.6;systolic blood pressure (SBP) <100 mmHg: 0.53/0.03;pulse >100/min: 1.42/0.2; platelets <14000/nL:1.5/0.2; INR >1.17: 1.89/0.049. In the multivariate analysis none of these variables independently predicted UGI-B.
  
  
  CONCLUSIONS
  No relevant pre-endoscopic variables for the prediction of active UGI-B at E-EGD could be found. Our data suggest that pre-endoscopic evaluation cannot replace rapid endoscopy.
authors.affiliation: Department of Internal Medicine , Ruhr-University Bochum Medical Centre, Herne, Germany. arnd.giese@rub.de
authors.forename: Arnd
authors.initials: A
authors.lastname: Giese
authors.forename: Catharina
authors.initials: C
authors.lastname: Grunwald
authors.forename: Jurgen
authors.initials: J
authors.lastname: Zieren
authors.forename: Nikolaus J
authors.initials: NJ
authors.lastname: Buchner
authors.forename: Bernhard F
authors.initials: BF
authors.lastname: Henning
mesh_terms: D039602:After-Hours Care; D000368:Aged; D000740:Anemia / Q000209:etiology; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D005858:Germany; D006396:Hematemesis / Q000209:etiology; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008551:Melena / Q000209:etiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors