Accurate triage of lower gastrointestinal bleed (LGIB) – A cohort study. (January 2016)

• Record Type: Journal Article
• Authors: Chong, Vincent; Hill, Andrew G.; MacCormick, Andrew D.
• Is Part Of: International journal of surgery. Volume 25(2016)
• Page Start: 19
• Page End: 23
• Publication Date: 2016-01
• Subjects: Gastrointestinal haemorrhage -- Triage -- Lower gastrointestinal tract; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2015.11.003
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Introduction: Acute lower gastrointestinal bleeding (LGIB) is a common acute presenting complaint to hospital. Unlike upper gastrointestinal bleeding, the diagnostic and therapeutic approach is not well-standardised. Intensive monitoring and urgent interventions are essential for patients with severe LGIB. The aim of this study is to investigate factors that predict severe LGIB and develop a clinical predictor tool to accurately triage LGIB in the emergency department of a busy metropolitan teaching hospital. Methods: We retrospectively identified all adult patients who presented to Middlemore Hospital Emergency Department with LGIB over a one year period. We recorded demographic variables, Charlson Co-morbidities Index, use of anticoagulation, examination findings, vital signs on arrival, laboratory test results, treatment plans and further investigations results. We then identified a subgroup of patients who suffered severe LGIB. Results: A total of 668 patients presented with an initial triage diagnosis of LGIB. 83 of these patients (20%) developed severe LGIB. Binary logistic regression analysis identified four independent risk factors for severe LGIB: use of aspirin, history of collapse, haemoglobin on presentation of less than 100 mg/dl and albumin of less than 38 g/l. Conclusions: We have developed a clinical prediction tool for severe LGIB in our population with a negative predictive value (NPV) of 88% and a positive predictive value (PPV) of 44% respectively. We aim to validate the clinical prediction tool in a further cohort to ensure stability of the multivariate model. Highlights: This study aims to improve clinical decision making in the emergency department for patients presenting with LGIB. The HAKA score predicts severe LGIB with a NPV of 88% and PPV of 44%. HAKA – H aemoglobin less than 100 mg/dl; Use of A spirin; history of (K) c ollapse; and A lbumin less than 38 g/l. This clinical prediction tool could be used to identify those high risk patients requiring admission while low risk patients could be safely and effectively treated as outpatients.