Acute lower gastrointestinal haemorrhage: outcomes and risk factors for intervention in 949 emergency cases

Abstract

ALGIH accounts for 1% of all ED presentations, with half requiring hospital admission. Mortality and surgical intervention rates are low and although most patients can be managed supportively, access to interventional radiology/endoscopy is important.

Factors Associated With Emergency Department Discharge, Outcomes and Follow-Up Rates of Stable Patients With Lower Gastrointestinal Bleeding

“…It is possible that older patients were more likely to be on ASA and were also more likely to be admitted presumably due to increased comorbid conditions. Nevertheless, other studies have demonstrated similar trends with anticoagulation and antiplatelet therapy being associated with a two-to fourfold increase in admissions for LGIB [6]. Ultimately, the safety of discharging stable patients on anticoagulation needs further evaluation with larger prospective studies.…”

“…While there have been a few recent studies evaluating safe and early discharge in low-risk patients, there are still no clear practice guidelines in the United States of America (USA) on risk stratification to determine safety for discharge from the emergency department (ED) as well as optimal timing of outpatient evaluation. A study in Germany by Kheng-Seong et al demonstrated that of 53% of patients admitted with LGIB, only 35% underwent lower endoscopy and only 4% had therapeutic intervention [ 6 ]. While this study further supported the limited utility of inpatient colonoscopies outcomes and follow-up data for those discharged from the ED were not specified.…”

Acute Lower Gastrointestinal Bleeding in an Emergency Department and Performance of the SHA2PE Score: A Retrospective Observational Study

“…Observational studies of patients with acute LGIB have often included only patients admitted to the hospital, and, of those, young patients with benign anorectal pathologies have usually been excluded [ 3 , 6 , 7 , 14 ], leading to a selection of more severe cases. In our study, patients were included based on a main concern of hematochezia at triage, before any discharge disposition was made, and explains the younger age of our cohort compared with that in other studies [ 3 , 6 , 7 , 8 ].…”

“…Observational studies of patients with acute LGIB have often included only patients admitted to the hospital, and, of those, young patients with benign anorectal pathologies have usually been excluded [ 3 , 6 , 7 , 14 ], leading to a selection of more severe cases. In our study, patients were included based on a main concern of hematochezia at triage, before any discharge disposition was made, and explains the younger age of our cohort compared with that in other studies [ 3 , 6 , 7 , 8 ]. However, apart from age, the patients’ characteristics were similar to those of previous studies regarding hemodynamic or laboratory parameters [ 7 ], the proportion of antiplatelet and anticoagulant treatments at admission [ 3 , 5 , 6 , 7 , 15 ], and comorbidities [ 3 , 5 , 14 , 16 ].…”

“…LGIB is associated with a mortality rate of 3–15% [ 1 , 3 , 4 ] and with elderly and polymorbid patients who are at higher risk of complications and death [ 5 , 6 ]. Hematochezia is the most common clinical manifestation of acute LGIB [ 7 ] and a frequent cause of emergency department (ED) consultation. Even if the bleeding stops spontaneously, it often leads to investigations during the ED or hospital stay and to significant costs [ 8 ].…”