Profile and Outcome of Patients with Upper Gastrointestinal Bleeding Presenting to Urban Emergency Departments of Tertiary Hospitals in Tanzania

Abstract

Background Upper Gastrointestinal Bleeding (UGIB) is a common Emergency Department (ED) presentation with high morbidity and mortality. There is a paucity of data on the profile and outcome of patients who present with UGIB to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania.Methodology This was a prospective cohort study of consecutive adult (≥18 years) patients presenting to the EDs of Muhimbili National Hospital (ED-MNH) and MUHAS Academic Medical Centre (ED-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. Patient demographic data, clinical presentation, and ED and hospital management provided were recorded. We used the clinical Rockall score to assess disease severity. The primary outcome was 7- day mortality and regression analysis was performed to identify predictors of mortality.Results During the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42 years (Interquartile range (IQR) 32-64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7 days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24 hours. There were no ED deaths. Upper GI endoscopy, was performed on 46 (37.4%) patients, of whom only 8 (17.4%) received endoscopy within 24 hours (early UGI endoscopy). All patients who received early UGI endoscopy had a low or moderate clinical Rockall score i.e. <3 and 3-4. No patient with scores of >4 received early UGI endoscopy. Age >40 years was a significant independent predictor of mortality (OR=7.00 (95% CI 1.7-29.2). Having a high clinical Rockall score of ≥4 was a significant independent predictor of mortality (OR=6.4 (95% CI 1.8-22.8)Conclusion In this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age > 40 years and clinical Rockall score ≥4 were independent predictors of higher mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy.