title: Accurate triage of lower gastrointestinal bleed (LGIB) - A cohort study.
abstract: BACKGROUND
  Acute lower gastrointestinal bleeding (LGIB) is a common acute presenting complaint to hospital. Unlike upper gastrointestinal bleeding, the diagnostic and therapeutic approach is not well-standardised. Intensive monitoring and urgent interventions are essential for patients with severe LGIB. The aim of this study is to investigate factors that predict severe LGIB and develop a clinical predictor tool to accurately triage LGIB in the emergency department of a busy metropolitan teaching hospital.
  
  
  METHODS
  We retrospectively identified all adult patients who presented to Middlemore Hospital Emergency Department with LGIB over a one year period. We recorded demographic variables, Charlson Co-morbidities Index, use of anticoagulation, examination findings, vital signs on arrival, laboratory test results, treatment plans and further investigations results. We then identified a subgroup of patients who suffered severe LGIB.
  
  
  RESULTS
  A total of 668 patients presented with an initial triage diagnosis of LGIB. 83 of these patients (20%) developed severe LGIB. Binary logistic regression analysis identified four independent risk factors for severe LGIB: use of aspirin, history of collapse, haemoglobin on presentation of less than 100 mg/dl and albumin of less than 38 g/l.
  
  
  CONCLUSIONS
  We have developed a clinical prediction tool for severe LGIB in our population with a negative predictive value (NPV) of 88% and a positive predictive value (PPV) of 44% respectively. We aim to validate the clinical prediction tool in a further cohort to ensure stability of the multivariate model.
authors.affiliation: Department of Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chong
authors.affiliation: Department of Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand; Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
authors.affiliation: Department of Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand; Department of Surgery, University of Auckland, Auckland, New Zealand. Electronic address: Andrew.Maccormick@middlemore.co.nz.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: MacCormick
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001241:Aspirin / Q000009:adverse effects; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000209:etiology*; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D014218:Triage / Q000379:methods* / Q000592:standards
chemical_list: D010975:Platelet Aggregation Inhibitors; D012709:Serum Albumin; D006441:Hemoglobin A; D001241:Aspirin
keywords: Gastrointestinal haemorrhage; Lower gastrointestinal tract; Triage