Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial☆,☆☆,★
Section snippets
PATIENTS AND METHODS
We prospectively screened all patients admitted with upper GI bleeding from our emergency department. Upper GI bleeding was defined as a history of vomiting or defecating fresh or altered blood in the preceding 7 days. Consecutive patients with upper GI bleeding were randomized only after they had been admitted and had a hospital bed assigned by the emergency department physician to exclude patients with trivial bleeding. Formal criteria were not used to assign the location of the admission to
RESULTS
Of 12,966 consecutive patients admitted from the emergency department during the 12-month study period, 312 had a diagnosis of upper GI bleeding. Two hundred six patients met at least one of the exclusion criteria including hemodynamic instability (80), known or suspected variceal bleeding (69), inability to consent (15), and miscellaneous reasons (37). Five eligible patients were missed from enrollment. Table 1 shows the baseline demographic and clinical characteristics of the study patients.
DISCUSSION
Our results show that endoscopy performed shortly after admission significantly decreased the use of health care resources and costs associated with caring for stable patients with nonvariceal upper GI bleeding by improving diagnostic and prognostic accuracy and expediting treatment. We discharged 46% of the patients who had low-risk findings on early endoscopy, none of whom experienced an adverse event. These results are similar to a smaller nonrandomized, uncontrolled study of early
Acknowledgements
We thank Drs. Steve Schutz and Martin L. Freeman for their thoughtful discussion of the manuscript.
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Cited by (0)
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Supported in part by grants from the American Digestive Health Foundation and the Hibbard E. Williams Research Award from the University of California, Davis Health System.
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Reprint request: John G. Lee, MD, Division of Gastroenterology, UC Davis Medical Center, 4150 V St., Room 3500, Sacramento, CA 95817; fax: 916-734-7908; e-mail: [email protected].
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