David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Laine L et al. Gastrointest Endosc 2017 Apr 7.

Rapidity of hospital presentation of upper gastrointestinal bleeding does not affect outcomes and should not alter the clinical approach.

The time between the onset of upper gastrointestinal bleeding (UGIB) and the presentation of symptoms varies widely. To identify factors that affect the time to presentation and to evaluate the effects on clinical outcomes of early and late presentation, investigators conducted a prospective study involving 2944 consecutive patients presenting with overt UGIB to six emergency departments in the U.S., U.K., New Zealand, Denmark, and Singapore between March 2014 and March 2015.

Results were as follows:

36% of patients presented within 6 hours of symptom onset, 51% presented within 12 hours, and 20% presented after 48 hours.

Patients mostly like to present early (within 6 hours) had altered mental status, albumin ≤30 g/L, and hematemesis; patients least likely to present early had melena and hemoglobin ≤80 g/L.

Factors not associated with time to presentation were presence of comorbidities, use of antithrombotic agents, hematochezia, gender, advanced age, and hemodynamic instability.

Separate analyses showed that, regardless of time to presentation, melena and low hemoglobin were associated with worse clinical outcomes (transfusions, intervention, rebleeding, and death) and that presence of comorbidities was associated with increased mortality.

Outcomes that did not vary with time to presentation were mortality, length of hospital stay, and the need for endoscopic therapy.

CITATION(S):

Laine L et al. Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes: A prospective study. Gastrointest Endosc 2017 Apr 7; [e-pub]. 

JWatch