title: Novel nasogastric tube-related criteria for urgent endoscopy in nonvariceal upper gastrointestinal bleeding.
abstract: BACKGROUND
  Patients with active upper gastrointestinal bleeding (UGIB) require urgent endoscopy, but appropriate criteria for urgent endoscopy in these patients have not yet been established.
  
  
  OBJECTIVE
  The goal of this study is to establish a simple system for the selection of UGIB patients who may benefit from urgent endoscopy.
  
  
  METHODS
  Of the 335 patients who required emergency hospitalization for UGIB from May 2010 to March 2012 at Nagoya Daini Red Cross Hospital, 166 patients who underwent placement of a nasogastric tube (NGT) were retrospectively identified. Active bleeding on the endoscopic image was used as an endpoint that reflected the need for urgent endoscopy.
  
  
  RESULTS
  The ratio of the heart rate to the systolic blood pressure (HR/SBP ratio) and aspiration of fresh or dark red fluid from the NGT [NGT(+)] were significant predictors of active bleeding in the univariate analysis [HR/SBP ratio, P=0.016; NGT(+), P<0.001]. The HR/SBP ratio [odds ratio (OR) 8.118; 95% confidence intervals (CI) 1.696-38.850; P=0.009] and NGT(+) (OR 4.630; 95% CI 2.092-10.204; P<0.001) were also significantly associated with active bleeding in the multivariate analysis. Moreover, receiver operating characteristic analysis revealed a setting with HR/SBP ratio>1.4 or NGT(+) to be optimal criteria to predict active bleeding. These criteria were associated with a sensitivity of 64.9% (24/37) and a specificity of 76.7% (99/129) for the prediction of active bleeding; consequently, they are superior to the sensitivity and specificity of previously proposed criteria.
  
  
  CONCLUSIONS
  A novel and simple criteria system using NGT(+) and HR/SBP is a good predictor of the need for urgent endoscopy in patients with nonvariceal UGIB.
authors.affiliation: Department of Gastroenterology, Nagoya Daini Red Cross Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya, 466-8650, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Takaya
authors.initials: T
authors.lastname: Shimura
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamada
authors.forename: Miho
authors.initials: M
authors.lastname: Aoki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nomura
authors.forename: Atsunori
authors.initials: A
authors.lastname: Kusakabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kanie
authors.forename: Tesshin
authors.initials: T
authors.lastname: Ban
authors.forename: Katsumi
authors.initials: K
authors.lastname: Hayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
authors.forename: Etsuro
authors.initials: E
authors.lastname: Orito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004632:Emergency Medical Services; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult