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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2017 | Original research

Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study

Authors: Pierre-Clément Thiebaud, Youri Yordanov, Jacques-Emmanuel Galimard, Pierre-Alexis Raynal, Sébastien Beaune, Laurent Jacquin, François-Xavier Ageron, Dominique Pateron, the Initiatives de Recherche aux Urgences Group

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2017

Abstract

Background

Upper gastrointestinal bleeding (UGB) is common in emergency departments (EDs) and can be caused by many eso-gastro-duodenal lesions. Most available epidemiological data and data on the management of UGB comes from specialized departments (intensive care units or gastroenterology departments), but little is known from the ED perspective.

We aimed to determine the distribution of symptoms revealing UGB in EDs and the hemorrhagic lesions identified by endoscopy. We also describe the characteristics of patients consulting for UGB, UGB management in the ED and patients outcomes.

Method

This was a prospective, observational, multicenter study covering 4 consecutive days in November 2013. Participating EDs were part of the Initiatives de Recherche aux Urgences network coordinated by the French Society of Emergency Medicine. All patients with suspected UGB in these EDs were included.

Results

In total, 110 EDs participated, including 194 patients with suspected UGB (median age 66 years [Q1-Q3: 51-81]). Overall, 104 patients (54%) had hematemesis and 75 (39%) melena. Endoscopy revealed lesions in 121 patients, mainly gastroduodenal ulcer or ulcerations (41%) or bleeding lesions due to portal hypertension (20%). The final diagnosis of UGB was reversed by endoscopy in only 3% of cases. Overall, 67 patients (35%) had at least one severity sign. Twenty-one patients died (11%); 40 (21%) were hospitalized in intensive care units and 126 (65%) in medicine departments; 28 (14%) were outpatients. Mortality was higher among patients with clinical and biological severity signs.

Conclusion

Most of the UGB cases in EDs are revealed by hematemesis. The emergency physician diagnosis of UGB is rarely challenged by the endoscopic findings.

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Title: Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study
Authors: Pierre-Clément Thiebaud
Youri Yordanov
Jacques-Emmanuel Galimard
Pierre-Alexis Raynal
Sébastien Beaune
Laurent Jacquin
François-Xavier Ageron
Dominique Pateron
the Initiatives de Recherche aux Urgences Group
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2017
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-017-0425-6

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Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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