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PubMed1985

Bleeding pattern before admission as guideline for emergency endoscopy.

In a prospective study of 539 patients admitted because of hematemesis and melena the bleeding pattern before admission was compared with the findings obtained on emergency endoscopy and the subsequent clinical course. Ranked in order of prognostic importance, red hematemesis with melena, black hematemesis with melena, and red hematemesis alone increased the probability of massive hemorrhage. Moreover, black hematemesis with melena was the superior predictor of bleeding ulcer, the commonest lesion carrying the risk of massive hemorrhage. In contrast, in patients with melena or black hematemesis alone massive hemorrhage occurred comparatively infrequently. The order of prognostic importance was supported by the transfusion requirement. In screening for a potentially life-threatening ulcer hemorrhage, emergency endoscopy is recommended in patients with black hematemesis with melena or with red hematemesis with or without melena. In patients presenting with black hematemesis or melena alone endoscopy may be postponed to the next convenient daytime.

Adolescent↗

PubMed1985

Clinical factors predisposing to major ulcer bleeding. A logistic regression analysis.

In a consecutive series of patients with bleeding from peptic ulcer, a logistic regression analysis was used to evaluate clinical factors as predictors of major hemorrhage. A hemodynamic assessment distinguished between self-limiting hemorrhage requiring no treatment (190 patients) and major bleeding necessitating emergency surgery (86 patients). Most data, including patient age and sex, previous bleeding, and pulse rate, blood pressure and hematocrit on admission, were poor predictors of major ulcer bleeding. A few variables--onset of hemorrhage, appearance of hematemesis and site of ulcer--were statistically of predictive importance, but clinically only in combination. When one of the selected predictor variables was present, the risk of major hemorrhage did not statistically exceed the prior probability. When combined in pairs, the probability increased, primarily when duodenal ulcer or red hematemesis was present. When the patients presented with three of the selected predictor variables, the probability of major ulcer hemorrhage was markedly increased. However, only 8% of the patients presented with three of the selected variables. Clinical factors, therefore, contribute in general little in prediction of major hemorrhage form peptic ulcer.

Adolescent↗