title: The Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room.
abstract: In countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities.The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients' priority for UGE.Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB.Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S.Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority.
authors.affiliation: From the Division of Liver Transplantation and Data Mining Research, Department of Hepatology and GIT; Senior Researcher (Al Azhar and Aswan University, Cairo, Asuit and Aswan, Egypt (AEAH); Department of Tropical, GI and Hepatology - Al Azhar School of Medicine-Asuit Branch-Al Azhar University-Asuit, Egypt (EMAE, HMM, MF, KAE); Department of Gynecology and Obstetrics, Al Azhar School of Medicine, Asuit Branch, Al Azhar University - Asuit, Egypt (MF); Department of Internal Medicine, Al Azhar School of Medicine, Al Azhar University, Cairo, Egypt (MA); Department of General and Laparoscopic Surgery, Al Azhar School of Medicine, Cairo (AR); Chest and Respiratory Intensive Care Unit, Aswan School of Medicine, Aswan University, Aswan, Egypt (SB); Department of Biochemistry, Faculty of Pharmacy, Suez canal University, Ismailia, Egypt (SEB); Graduate Medical Student, Egypt (KS); Department of Hepatology, UCLA, USA; Research Assistant (RAE); Department of Hepatology, National Liver Institute, Menofiya University-Menofiya, Egypt (MOA); Department of Radiology, Asuit faculty of Medicine, Asuit University, Asuit, Egypt (SH); Department of Clinical Pharmacy, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia (ASB); Departments of Clinical Pharmacology, Medicine and Cardiovascular Diseases, College of Medicine and Health Sciences (CMHS), University of Arab Emirates (AAE, SKA, AS); UAE-Emirates (AAE, SA, AS).
authors.forename: Abd Elrazek
authors.initials: AE
authors.lastname: Abd Elrazek
authors.forename: Hamdy
authors.initials: H
authors.lastname: Mahfouz
authors.forename: Khaled Abd
authors.initials: KA
authors.lastname: Elazeem
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fakhry
authors.forename: Emad Abd
authors.initials: EA
authors.lastname: Elrazek
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Foad
authors.forename: Mohamed
authors.initials: M
authors.lastname: Alboraie
authors.forename: Aly
authors.initials: A
authors.lastname: Ragab
authors.forename: Shazly
authors.initials: S
authors.lastname: Baghdady
authors.forename: Shymaa E
authors.initials: SE
authors.lastname: Bilasy
authors.forename: Khaled
authors.initials: K
authors.lastname: Salama
authors.forename: Ramy Abdel
authors.initials: RA
authors.lastname: Masseih
authors.forename: Mohamed Omar
authors.initials: MO
authors.lastname: Amer
authors.forename: Sayed
authors.initials: S
authors.lastname: Hassaneen
authors.forename: Akshaya Srikanth
authors.initials: AS
authors.lastname: Bhagavathula
authors.forename: Asim Ahmed
authors.initials: AA
authors.lastname: Elnour
authors.forename: Saif K
authors.initials: SK
authors.lastname: Al Nuaimi
authors.forename: Abdullah
authors.initials: A
authors.lastname: Shehab
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004932:Esophageal and Gastric Varices; D004941:Esophagitis / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D005756:Gastritis / Q000150:complications / Q000000981:diagnostic imaging; D005767:Gastrointestinal Diseases / Q000150:complications / Q000000981:diagnostic imaging; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014218:Triage / Q000379:methods*; D014463:Ultrasonography; D055815:Young Adult