Clinical predictors of outcome in acute upper gastrointestinal bleeding
| dc.contributor.author | Kalula, S.Z. | |
| dc.contributor.author | Swingler, G. | |
| dc.contributor.author | Louw, J.A. | |
| dc.date.accessioned | 2016-01-05T07:10:29Z | |
| dc.date.available | 2016-01-05T07:10:29Z | |
| dc.date.issued | 2003 | |
| dc.date.updated | 2015-12-22T08:31:56Z | |
| dc.description.abstract | Objective: Endoscopy has traditionally been used to risk-stratify patients with upper gastrointestinal bleeding (UGIB). This is problematic in resource-poor environments. The study aimed to identify patients who would not require urgent endoscopy by identifying clinical variables before endoscopy that predict uneventful recovery. Design: Prospective, descriptive cross-sectional study. Setting. Groote Schuur Hospital, Cape Town. Subjects: Two hundred consecutive patients aged over 12 years, presenting with haematemesis and/or melaena. Outcome measures: Good outcome, i.e. no blood transfusion, endotherapy or surgery, and alive at 1 month following presentation. Results: Eighty patients (40%) had a good outcome. Haemoglobin > 10 g/dl (odds ratio (OR) 25.5, 95% confidence interval (CI): 8.9 - 74.8; p < 0.001), absence of melaena (OR 4.8, 95% CI: 1.79 - 12.94, p = 0.002) and absence of syncope (OR 4.0, 95% CI: 1.67 - 9.48; p = 0.002) were independent predictors of good outcome. The three variables combined as a positive test had the best association with good outcome when compared with a single variable or a combination of two variables. The three-variable model had sensitivity for good outcome of 34%, specificity of 98%, and likelihood ratio for a positive test of 13.5 and for a negative test of 0.68. Thirty patients (15%) had the combination for the prediction rule, i.e. haemoglobin > 10 g/dl, no melaena and no syncope; 3 (10%) had a poor outcome (required endotherapy). Conclusion: The prediction rule accurately excluded poor outcome, a priority in the clinical context, but did not predict good outcome. Clinical implications are a 15% reduction in unnecessary urgent endoscopies, with less than 5% of patients with poor outcome not undergoing urgent endoscopy. These findings may have particular clinical relevance in under-resourced health care environments. | en_ZA |
| dc.identifier.apacitation | Kalula, S. Z., Swingler, G., & Louw, J. A. (2003). Clinical predictors of outcome in acute upper gastrointestinal bleeding. <i>South African Medical Journal</i>, http://hdl.handle.net/11427/16210 | en_ZA |
| dc.identifier.chicagocitation | Kalula, S.Z., G. Swingler, and J.A. Louw "Clinical predictors of outcome in acute upper gastrointestinal bleeding." <i>South African Medical Journal</i> (2003) http://hdl.handle.net/11427/16210 | en_ZA |
| dc.identifier.citation | Kalula, S. Z., Swingler, G. H., & Louw, J. A. (2003). Clinical predictors of outcome in acute upper gastrointestinal bleeding: original article. South African Medical Journal, 93(4), p-286. | en_ZA |
| dc.identifier.issn | 0256-9574 | en_ZA |
| dc.identifier.ris | TY - Journal Article AU - Kalula, S.Z. AU - Swingler, G. AU - Louw, J.A. AB - Objective: Endoscopy has traditionally been used to risk-stratify patients with upper gastrointestinal bleeding (UGIB). This is problematic in resource-poor environments. The study aimed to identify patients who would not require urgent endoscopy by identifying clinical variables before endoscopy that predict uneventful recovery. Design: Prospective, descriptive cross-sectional study. Setting. Groote Schuur Hospital, Cape Town. Subjects: Two hundred consecutive patients aged over 12 years, presenting with haematemesis and/or melaena. Outcome measures: Good outcome, i.e. no blood transfusion, endotherapy or surgery, and alive at 1 month following presentation. Results: Eighty patients (40%) had a good outcome. Haemoglobin > 10 g/dl (odds ratio (OR) 25.5, 95% confidence interval (CI): 8.9 - 74.8; p < 0.001), absence of melaena (OR 4.8, 95% CI: 1.79 - 12.94, p = 0.002) and absence of syncope (OR 4.0, 95% CI: 1.67 - 9.48; p = 0.002) were independent predictors of good outcome. The three variables combined as a positive test had the best association with good outcome when compared with a single variable or a combination of two variables. The three-variable model had sensitivity for good outcome of 34%, specificity of 98%, and likelihood ratio for a positive test of 13.5 and for a negative test of 0.68. Thirty patients (15%) had the combination for the prediction rule, i.e. haemoglobin > 10 g/dl, no melaena and no syncope; 3 (10%) had a poor outcome (required endotherapy). Conclusion: The prediction rule accurately excluded poor outcome, a priority in the clinical context, but did not predict good outcome. Clinical implications are a 15% reduction in unnecessary urgent endoscopies, with less than 5% of patients with poor outcome not undergoing urgent endoscopy. These findings may have particular clinical relevance in under-resourced health care environments. DA - 2003 DB - OpenUCT DP - University of Cape Town J1 - South African Medical Journal LK - https://open.uct.ac.za PB - University of Cape Town PY - 2003 SM - 0256-9574 T1 - Clinical predictors of outcome in acute upper gastrointestinal bleeding TI - Clinical predictors of outcome in acute upper gastrointestinal bleeding UR - http://hdl.handle.net/11427/16210 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/16210 | |
| dc.identifier.vancouvercitation | Kalula SZ, Swingler G, Louw JA. Clinical predictors of outcome in acute upper gastrointestinal bleeding. South African Medical Journal. 2003; http://hdl.handle.net/11427/16210. | en_ZA |
| dc.language | eng | en_ZA |
| dc.publisher | Health and Medical Publishing Group | en_ZA |
| dc.publisher.department | Division of Geriatric Medicine | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights | Creative Commons Attribution - Noncommercial 3.0 Unported Works License (CC BY-NC 3.0) | * |
| dc.rights.uri | https://creativecommons.org/licenses/by-nc/3.0/ | en_ZA |
| dc.source | South African Medical Journal | en_ZA |
| dc.source.uri | http://www.samj.org.za/index.php/samj | |
| dc.title | Clinical predictors of outcome in acute upper gastrointestinal bleeding | en_ZA |
| dc.type | Journal Article | en_ZA |
| uct.type.filetype | ||
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |