Outpatient management of upper digestive hemorrhage not associated with portal hypertension: a large prospective cohort

Abstract

Treatment under an outpatient regime is a safe alternative for a large percentage of selected patients with UGIH not associated with portal hypertension.

Prospective evaluation of a clinical guideline recommending early patients discharge in bleeding peptic ulcer

“…The percentage of patients classified as low‐risk and therefore candidates for outpatient management, using the predictive variables obtained in the multivariate analysis (blood pressure ≥ 100 mmHg, heart rate ≤ 100 bpm and a Forrest III ulcer) was 34%, a figure similar to that reported in previous studies, 10,25–28 but only 10% of the patients were immediately discharged in our retrospective study 4 …”

Risk Assessment and Outpatient Management in Bleeding Peptic Ulcer

“…25,29,32,33 As in almost all studies, mortality was zero in our patients classified as low risk 12,13,25,29,32 ; only very occasionally has mortality been reported, with rates of 0.1%, 33 1%, 26 1.4%, 13 or 1.5%. 30 Our findings suggest that a high number of low-risk patients were unnecessarily admitted to hospital (115 patients could have been discharged without risk of rebleeding; rebleeding in fact occurred in only 33). Furthermore, mean length of hospital stay was quite high (8.4 days), and in patients with Forrest III lesions it was also around this figure (however, this may be partly due to a few patients who presented complications unrelated to UGIB, which markedly prolonged hospitalization; data not shown).…”

“…Several studies prior to ours have evaluated the possibility of immediate hospital discharge in UGIB patients. 10,11,13,24,26,29,30 The percentage of patients classified as low risk and, therefore, candidates for outpatient management, oscillates between 8% and 50%, but in most cases it is around 25%. 12,[29][30][31][32][33] If predictive variables obtained in the multivariate analysis had been used (blood pressure $100 mm Hg, heart rate #100 bpm, and Forrest IIc or III ulcer), hospitalization could have been prevented in 115 patients (that is, in 34% of the cases).…”

A Canadian Clinical Practice Algorithm for the Management of Patients with Non-Variceal Upper Gastrointestinal Bleeding

“…Clinical and endoscopic classification of risk allows for safe and prompt discharge of patients classified as low-risk; improves patient outcomes for patients classified as high-risk; and reduces resource utilization for patients in all classifications (11,(38)(39)(40)(41)(42)(43)(44). Clinical criteria for early discharge generally include age less than 60 years, stable vital signs, no endoscopic stigmata or flat spot, and no concomitant serious medical illness (39,45).…”