title: Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes: a prospective study.
abstract: OBJECTIVE
  We performed a prospective multi-national study of patients presenting to the emergency department with upper GI bleeding (UGIB) and assessed the relationship of time to presentation after onset of UGIB symptoms with patient characteristics and outcomes.
  
  
  METHODS
  Consecutive patients presenting with overt UGIB (red-blood emesis, coffee-ground emesis, and/or melena) from March 2014 to March 2015 at 6 hospitals were included. Multiple predefined patient characteristics and outcomes were collected. Rapid presentation was defined as ≤6 hours.
  
  
  RESULTS
  Among 2944 patients, 1068 (36%) presented within 6 hours and 576 (20%) beyond 48 hours. Significant independent factors associated with presentation ≤6 hours versus >6 hours on logistic regression included melena (odds ratio [OR], 0.22; 95% CI, 0.18-0.28), hemoglobin ≤80 g/L (OR, 0.47; 95% CI, 0.36-0.61), altered mental status (OR, 2.06; 95% CI, 1.55-2.73), albumin ≤30 g/L (OR, 1.43; 95% CI, 1.14-1.78), and red-blood emesis (OR, 1.29; 95% CI, 1.06-1.59). Patients presenting ≤6 hours versus >6 hours required transfusion less often (286 [27%] vs 791 [42%]; difference, -15%; 95% CI, -19% to -12%) because of a smaller proportion with low hemoglobin levels, but were similar with regard to hemostatic intervention (189 [18%] vs 371 [20%]), 30-day mortality (80 [7%] vs 121 [6%]), and hospital days (5.0 ± 0.2 vs 5.0 ± 0.2).
  
  
  CONCLUSIONS
  Patients with melena alone delay their presentation to the hospital. A delayed presentation is associated with a decreased hemoglobin level and increases the likelihood of transfusion. Other outcomes are similar with rapid versus delayed presentation. Time to presentation should not be used as an indicator for poor outcome. Patients with delayed presentation should be managed with the same degree of care as those with rapid presentation.
authors.affiliation: Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA; VA Connecticut Healthcare System, West Haven, Connecticut, USA.
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
authors.affiliation: Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.
authors.forename: Stig B
authors.initials: SB
authors.lastname: Laursen
authors.affiliation: Gastrointestinal Unit, Royal Cornwall Hospital, Cornwall, United Kingdom.
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
authors.affiliation: Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore.
authors.forename: Jing H
authors.initials: JH
authors.lastname: Ngu
authors.affiliation: Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Schultz
authors.affiliation: Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Stanley
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003221:Confusion / Q000209:etiology; D004378:Duodenal Diseases / Q000097:blood* / Q000401:mortality / Q000628:therapy; D004935:Esophageal Diseases / Q000097:blood* / Q000401:mortality / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006396:Hematemesis / Q000097:blood* / Q000401:mortality / Q000628:therapy; D006454:Hemoglobins / Q000378:metabolism; D016558:Hemostasis, Endoscopic / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D053609:Lethargy / Q000209:etiology; D008297:Male; D008551:Melena / Q000097:blood* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013272:Stomach Diseases / Q000097:blood* / Q000401:mortality / Q000628:therapy; D053608:Stupor / Q000209:etiology; D061665:Time-to-Treatment
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin