Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study

Abstract

BACKGROUND: Many scoring systems for predicting mortality, rebleeding and transfusion needs among patients with upper gastrointestinal bleeding (UGIB) have been developed. However, no scoring system can predict all these outcomes. OBJECTIVE: To show whether the perfusion index (PI), compared with the Rockall score (RS), helps predict transfusion needs and prognoses among patients presenting with UGIB in emergency departments. In this way, critical patients with transfusion needs can be identified at an early stage. DESIGN AND SETTING: Prospective cohort study in an emergency department in Turkey, conducted between June 2018 and June 2019. METHODS: Patients' demographic parameters, PI, RS, transfusion needs and prognosis were recorded. RESULTS: A total of 219 patients were included. Blood transfusion was performed in 174 patients (79.4%). The PI cutoff value for prediction of the need for blood transfusion was 1.17, and the RS cutoff value was 5. The area under the curve (AUC) value for PI (AUC: 0.772; 95% confidence interval, CI: 0.705-0.838; P < 0.001) was higher than for RS (AUC: 0.648; 95% CI: 0.554-0.741; P = 0.002). 185 patients (84.5%) were discharged, and 34 patients (15.5%) died. The PI cutoff value for predicting mortality was 1.1, and the RS cutoff value was 7. The AUC value for PI (AUC: 0.743; 95% CI: 0.649-0.837; P < 0.001) was higher than for RS (AUC: 0.725; 95% CI: 0.639-0.811; P < 0.001). CONCLUSION: PI values for patients admitted to emergency departments with UGIB on admission can help predict their need for transfusion and mortality risk.

Outcomes of Implementing a Care Bundle for the Early Management of Patients with Acute Upper Gastrointestinal Bleeding

“…The finding of the current study is supported by a study of using perfusion index as a tool for fluid replacement of upper GIT bleeding patients where there was a significant relation between MAP of both groups (Firat et al, 2021). Other review studies suggested that the use of a standardized and bundled care can improve patients perfusion through maintaining normal MAP in patients with upper GIT bleeding (Haigh, 2022;Siau et al, 2020).…”

A Cross-Sectional Study on the Agreement of Perfusion Indexes Measured on Different Fingers by a Portable Pulse Oximeter in Healthy Adults

“…The PI in emergency departments helps in the identification of the need for transfusion [ 20 ]. It also helps to estimate the mortality risk in patients presenting with upper gastrointestinal bleeding and mortality in mechanically ventilated patients [ 21 , 22 ]. Moreover, it helps in the detection of hypotension during anesthesia and to identify the effectiveness of ganglion blocks [ 6 , 7 ].…”