Soiling of the airway was associated with a reduced firstpass success during emergency intubation, and this reduction occurred to a similar degree whether using either the GlideScope or the direct laryngoscope.
predictor of those needing urgent endoscopy. All of these data highlight the need to identify those with UGIB who do not need urgent endoscopy or even further inpatient evaluation. We sought to determine if the addition of nasogastric lavage results would augment risk assessment achieved by non-invasive means with scoring systems like GBS and AIMS65 in acute UGIB. Methods: Sensitivity and specificity for NG lavage was obtained from several comparable studies on non-variceal UGIB. Due to the wide range of data, sensitivity and specificity for NG lavage was divided into low and high range and likelihood ratio (LR) were calculated. Percentage risk used as pretest probability and LR for NG lavage were inserted into the Bayesian nomogram to obtain posttest probabilities. Absolute (ADG) and relative diagnostic gains (RDG) were then calculated. ANOVA was used to evaluate strength of association with a P value set at .05. Results: Sensitivity of 0.42 and specificity of .54 for low range with a LR+ of 0.91 and 0.84 and 0.91, LR + 9.33 for high range respectively. Using low range values for NG lavange and AIMS 65 low risk resulted in a post test probability of 3%, ADG and RDG of 0%. Low range NG lavage and GBS low risk population resulted in a post test probability of 5% with 0% ABDG and RDG. High range values for NG lavage and AIMS 65 low risk pretest probability yielded a post test probability of 22%, ADG of 19% and RDG of 633.3%. For high range NG lavage and low risk GBS post test probability was 33%, ADG of 28% and RDG 560%. ANOVA for low range NG lavage P ¼ 1.0; for high range P ¼ .95. Conclusion: After combining the LRs for NG lavage from several comparable studies on non-variceal UGIB and using the low end LR (0.91) with both the GBS and AIM65 scores, there was zero absolute or relative gain in post-test probability for those with lowrisk as determined by the non-invasive scoring systems. On ANOVA analysis, there was no incremental benefit of NG lavage to non-invasive scoring systems for low-risk patients even when using the high end of LR (9.33). For patients with low-risk of need for endoscopic intervention or mortality based on the GBS or AIMS65 scoring systems, nasogastric lavage provides no additional yield in predicting these poor outcomes. In patients with a low score on GBS or AIMS65, nasogastric lavage should not be performed.
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