Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes: a prospective study

• Published in: Gastrointestinal endoscopy 2017-12, Vol.86 (6), p.1028-1037
• Main Authors: Laine, Loren, MD, Laursen, Stig B., MD, PhD, Dalton, Harry R., DPhil, DipMedEd, Ngu, Jing H., MBChB, PhD, Schultz, Michael, MD, Dr Habil (Germany), Stanley, Adrian J., MBChB, MD
• Format: Article
• Language: English
• Subjects: Aged; Blood Transfusion - statistics & numerical data; Confusion - etiology; Duodenal Diseases - blood; Duodenal Diseases - mortality; Duodenal Diseases - therapy; Esophageal Diseases - blood; Esophageal Diseases - mortality; Esophageal Diseases - therapy; Female; Gastroenterology and Hepatology; Glasgow Coma Scale; Hematemesis - blood; Hematemesis - mortality; Hematemesis - therapy; Hemoglobins - metabolism; Hemostasis, Endoscopic - statistics & numerical data; Humans; Length of Stay - statistics & numerical data; Lethargy - etiology; Male; Melena - blood; Melena - mortality; Melena - therapy; Middle Aged; Patient Acceptance of Health Care - statistics & numerical data; Prognosis; Prospective Studies; Serum Albumin - metabolism; Stomach Diseases - blood; Stomach Diseases - mortality; Stomach Diseases - therapy; Stupor - etiology; Time-to-Treatment
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2017.03.1549

Background and Aims 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.