Acute gastrointestinal bleeding cases presenting to the emergency department are associated with age, sex and seasonal and circadian factors.
BACKGROUND
Gastrointestinal bleeding (GIB) is one of the most common emergencies in gastroenterology. The aim of this study was to investigate the association between the incidence of GIB and seasonal, circadian and meteorological patterns in the emergency department (ED) of a tertiary hospital.


METHODS
From January 2007 until December 2012, we retrospectively evaluated patients presenting to the ED with respect to the number and location of GIB, season, time of day and weather.


RESULTS
Of 45 458 patients, 578 (1.3%) presented with a GIB. Of these, 62.5% were men compared with 54.7% of all patients in the ED (χ, P=0.0002). Patients with GIB were on average 4.4 years older than those without GIB (95% confidence interval 2.76-5.98, t-test, P<0.001). In addition, 304 (52.6%) patients had upper GIB and 138 (23.9%) had lower GIB. In total, 136 (23.5%) patients required no endoscopy because of initial laboratory and circulatory stability. In univariate analysis, meteorological parameters, including air temperature, cloud cover, relative humidity, vapour pressure, amount of precipitation, sunshine duration and snow height, were each associated with an increased risk of acute GIB (all P-values<0.05). In the 6-year study period, patients with GIB presented to the ED mainly during the winter months. Independent predictors of GIB on multivariate logistic regression were older age, male sex, season and daytime, all P less than 0.005. Emergency admissions during the night were associated with a 54 and 35% higher risk of GIB compared with daytime (8 a.m. to 4 p.m., P=0.0002) and late evening hours (4 p.m. to midnight, P=0.0142), respectively.


CONCLUSIONS
Presentation of patients with acute GIB in the ED is age and sex specific and shows seasonal and circadian differences in distribution, with an increased incidence in winter months and during night-time. This should be considered when determining possible emergency endoscopic interventions and the availability of emergency endoscopy services.
Departments of aGastroenterology, Hepatology and Endocrinology bBiostatistics cRespiratory Medicine dIntegrated Research and Treatment Center - Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.
Henrike
H
Lenzen
Eliane
E
Musmann
Martina
M
Kottas
Bastian
B
Schönemeier
Thomas
T
Köhnlein
Michael P
MP
Manns
Tim O
TO
Lankisch
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D039602:After-Hours Care; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002940:Circadian Rhythm; D004636:Emergency Service, Hospital; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D005858:Germany / Q000453:epidemiology; D016558:Hemostasis, Endoscopic; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D012737:Sex Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D014887:Weather; D055815:Young Adult