title: Outcome following a negative CT Angiogram for gastrointestinal hemorrhage.
abstract: OBJECTIVE
  This study was designed to evaluate the role of a negative computed tomography angiogram (CTA) in patients who present with gastrointestinal (GI) hemorrhage.
  
  
  METHODS
  A review of all patients who had CTAs for GI hemorrhage over an 8-year period from January 2005 to December 2012 was performed. Data for patient demographics, location of hemorrhage, hemodynamic stability, and details of angiograms and/or the embolization procedure were obtained from the CRIS/PACS database, interventional radiology database, secure electronic medical records, and patient's clinical notes.
  
  
  RESULTS
  A total of 180 patients had 202 CTAs during the 8-year period: 87 CTAs were performed for upper GI hemorrhage (18 positive for active bleeding, 69 negative) and 115 for lower GI hemorrhage (37 positive for active bleeding, 78 negative); 58.7 % (37/63) of patients with upper GI bleed and 77.4 % (48/62) of patients with lower GI bleed who had an initial negative CTA did not rebleed without the need for radiological or surgical intervention. This difference was statistically significant (p = 0.04). The relative risk of rebleeding, following a negative CTA, in lower GI bleeding versus upper GI bleeding patients is 0.55 (95 % confidence interval 0.32-0.95).
  
  
  CONCLUSIONS
  Patients with upper GI bleed who had negative CTAs usually require further intervention to stop the bleeding. In contrast, most patients presenting with lower GI hemorrhage who had a negative first CTA were less likely to rebleed.
authors.affiliation: Department of Radiology, Level 2, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK, drvictoriac@gmail.com.
authors.forename: Victoria
authors.initials: V
authors.lastname: Chan
authors.forename: Donald
authors.initials: D
authors.lastname: Tse
authors.forename: Shaheen
authors.initials: S
authors.lastname: Dixon
authors.forename: Vivek
authors.initials: V
authors.lastname: Shrivastava
authors.forename: Mark
authors.initials: M
authors.lastname: Bratby
authors.forename: Suzie
authors.initials: S
authors.lastname: Anthony
authors.forename: Rafiuddin
authors.initials: R
authors.lastname: Patel
authors.forename: Charles
authors.initials: C
authors.lastname: Tapping
authors.forename: Raman
authors.initials: R
authors.lastname: Uberoi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D014057:Tomography, X-Ray Computed