Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study.
OBJECTIVE
To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.


METHODS
We interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3.


RESULTS
The population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8%c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489,P< 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions.


CONCLUSIONS
GIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.
Thomas M Attard, Department of Gastroenterology, Children's Mercy Hospital, Kansas, MO 64108, United States.
Thomas M
TM
Attard
Thomas M Attard, Department of Gastroenterology, Children's Mercy Hospital, Kansas, MO 64108, United States.
Mikaela
M
Miller
Thomas M Attard, Department of Gastroenterology, Children's Mercy Hospital, Kansas, MO 64108, United States.
Chaitanya
C
Pant
Thomas M Attard, Department of Gastroenterology, Children's Mercy Hospital, Kansas, MO 64108, United States.
Ashwath
A
Kumar
Thomas M Attard, Department of Gastroenterology, Children's Mercy Hospital, Kansas, MO 64108, United States.
Mike
M
Thomson
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D007223:Infant; D007297:Inpatients; D008297:Male; D010343:Patient Admission; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Endoscopy; Gastrointestinal hemorrhage; Hospital Information Systems; Liver disease; Mortality; Octreotide; Pediatrics; Proton pump inhibitors