The Predictive Model for Emergency Physicians Deciding todmit Patients of Acute Upper Gastrointestinal Hemorrhage
Date Issued
2008
Date
2008
Author(s)
Wu, Yuan-Hui
Abstract
Background: Acute upper gastrointestinal hemorrhage is a common disease of emergency medicine. Patients with severe hemorrhage have potential of mortality and admission should be arranged. Patients with stable condition may be discharged after a short-term emergency management. There is no consensus among emergency physicians deciding to admit a patient or not currently.bjective: I attempted to establish a predictive model for emergency physicians deciding to admit patients of acute upper gastrointestinal hemorrhage and another predictive model of total length of stay among these patients.ethods: To perform the retrospective study, the data were collected from the hospital information system and paper medical record. I collected data of patients visiting emergency department with any cause of upper gastrointestinal hemorrhage at a 1000-acute-bed teaching hospital in Taipei county from Jan. 1, 2006 to Jun. 30, 2006. I enrolled patients with a major problem of upper gastrointestinal hemorrhage, without previous hemorrhage within 30 days, severe acute comorbidities and needs of trans-arterial embolization, surgery, or intensive care unit admission. All the enrolled patient were separated into the following two groups. In ED group, patients received all the management in the emergency department and were discharged by emergency physician finally. In Ward group, patients were admitted to general ward after emergency management and were discharged by gastroenterologist finally. I compared the variables of demography, past history, drug history, symptoms, duration from symptoms onset to arrival, vital signs, lab data, transfused blood units, endoscopic diagnoses and stigmata, with or without any hemostasis procedure and so on between these two groups. Multiple logistic regressions were used to analyze the predictive factors of admission. Linear regressions were used to analyze the predictive factors of total length of stay.esults: There were 690 cases of acute upper gastrointestinal hemorrhage visiting the emergency department of the hospital during the study period. Three hundred and forty-three cases were enrolled to the data base. Three hundred and thirty-five of them, including 132 cases in ED group and 203 cases in Ward group, had complete data and entered to both logistic and linear regression analysis mentioned above. After adjusting and removing more nonsignificant variables, liver disease, initial hemoglobin and most severe endoscopic diagnosis had most influence to decide admission or not. The odds ratio of Forrest II ulcer compared with non-varice-non-ulcer diagnosis was 66.738; the odds ratio of Forrest I ulcer was 61.107; the odds ratio of varice is 24.813. Admission was highly suggested at these diagnoses. After adjusting and removing more nonsignificant variables, Numbers of systems that chronic diseases involved, NSAID use, transfused blood units, most severe endoscopic diagnosis and endoscopic hemostasis procedure had most influence of total length of stay. The endoscopic diagnosis and hemostasis procedure were the most important factors of total length of stay. Compared with non-varice-non-ulcer diagnosis, it would increase 0.915, 1.209, 1.357 and 2.106 days in total length of stay when the most severe diagnoses were Forrest III ulcer, Forrest II ulcer, Forrest I ulcer and varice respectly. Another 1.728 days would be added to total length of stay if hemostasis procedure were performed. onclusions: In the study hospital, liver disease, initial hemoglobin and most severe endoscopic diagnosis were the most important predictive factors for emergency physician deciding to admit patients of acute upper gastrointestinal hemorrhage. Numbers of systems that chronic diseases involved, NSAID use, transfused blood units, most severe endoscopic diagnosis and endoscopic hemostasis procedure were the most important predictive factors for total length of stay.
Subjects
upper gastrointestinal hemorrhage
emergency department
predictive model
regression
Type
thesis
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