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Critical Care

, 12:R57

First Online: 22 April 2008Received: 28 January 2008Revised: 08 April 2008Accepted: 22 April 2008


IntroductionMany patients presenting with acute gastrointestinal hemorrhage GIH are admitted to the intensive care unit ICU for monitoring. A simple triage protocol based upon validated risk factors could decrease ICU utilization.

MethodsRecords of 188 patients admitted with GIH from the emergency department ED were reviewed for BLEED criteria visualized red blood, systolic blood pressure below 100 mm Hg, elevated prothrombin time PT, erratic mental status, and unstable comorbid disease and complication within the first 24 hours of admission. Variables associated with early complication were reassessed in 132 patients prospectively enrolled as a validation cohort. A triage model was developed using significant predictors.

ResultsWe studied 188 patients in the development set and 132 in the validation set. Red blood relative risk RR 4.53, 95% confidence interval CI 2.04, 10.07 and elevated PT RR 3.27, 95% CI 1.53, 7.01 were significantly associated with complication in the development set. In the validation cohort, the combination of red blood or unstable comorbidity had a sensitivity of 0.73, a specificity of 0.55, a positive predictive value of 0.24, and a negative predictive value of 0.91 for complication within 24 hours. In simulation studies, a triage model using these variables could reduce ICU admissions without increasing the number of complications.

ConclusionPatients presenting to the ED with GIH who have no evidence of ongoing bleeding or unstable comorbidities are at low risk for complication during hospital admission. A triage model based on these variables should be tested prospectively to optimize critical care resource utilization in this common condition.

AbbreviationsAPACHE IIAcute Physiology and Chronic Health Evaluation II

BLEED = ongoing BleedingLow systolic blood pressure, Elevated prothrombin time, Erratic mental status, and unstable comorbid Disease

BPblood pressure

CIconfidence interval

EDemergency department

GIHgastrointestinal hemorrhage

ICUintensive care unit


PTprothrombin time

RRrelative risk

Electronic supplementary materialThe online version of this article doi:10.1186-cc6878 contains supplementary material, which is available to authorized users.

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Autor: Aneesa M Das - Namita Sood - Katherine Hodgin - Lydia Chang - Shannon S Carson


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