Original ArticlesIncremental value of upper endoscopy for triage of patients with acute non-variceal upper-GI hemorrhage☆
Section snippets
Patients and methods
An historical cohort study was conducted by using existing medical record data for patients admitted to a tertiary care, university affiliated hospital with acute UGIH. The office for the protection of research subjects of our university approved the study. Potential cases were identified via an electronic search of an administrative database containing data on all consecutive adult patients (>18 years of age) hospitalized during calendar years 1997 and 1998. These years were chosen because
Results
A total of 175 adult patients (mean age 62 [19] years) with acute, non-variceal UGIH were identified during the study period; 54% (95/175) were men. Almost half (46%) were actively taking non-steroidal anti-inflammatory drugs (NSAID), including aspirin, at the time of hospital admission. The most common endoscopic diagnoses were gastric ulcer (40 patients, 23%) and duodenal ulcer (23 patients, 13%) (Fig. 1). Two thirds of all patients and 72% of those with a complete Rockall Risk Score of less
Discussion
With continued increases in the cost of health care, the appropriateness of expensive in-hospital treatment has come under growing scrutiny by health care policy planners. As a result, the delivery of health care by gastroenterologists is increasingly being shifted to the outpatient setting. A key concern for health care providers is that efforts to decrease inappropriate use of services do not inadvertently place restrictions on access to necessary care. Because acute UGIH is among the most
Acknowledgments
We wish to thank Tommy T. Oei, MD, and Dong Chang, MD, for assistance with data collection.
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Dr. Gralnek is supported by a VA HSR&D Advanced Research Career Development Award and VA HSR&D IIR 01-191-1. Dr. Dulai is supported by an NIH/NCRR K23 Career Development Award 1618801.