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Acute lower gastrointestinal haemorrhage: outcomes and risk factors for intervention in 949 emergency cases

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Outcomes of acute lower gastrointestinal haemorrhage (ALGIH) are mostly derived from studies performed in the sub-acute/elective rather than the emergency department (ED) setting. The aims of this study were to determine the incidence and outcomes of patients presenting to a tertiary hospital ED with ALGIH and to identify associated clinicopathological risk factors.

Method

A retrospective observational cohort study of consecutive patients presenting with ALGIH to a tertiary hospital ED was performed. Primary outcome measures included mortality and hospital (including high dependency [HDU]) admission. Secondary outcome measures included rates of (i) blood transfusion, (ii) radiological/endoscopic investigation(s) and (iii) therapeutic intervention.

Results

ALGIH accounted for 949 (512 M, mean age 62.3 years) of 130,262 (0.73%) ED presentations, of which 285 patients (30.1%) were on anti-platelet/coagulant therapy. There were five deaths (0.5%). Hospital admission was required in 498 patients (52.5%), of which 19 (3.8%) required HDU monitoring. Hospital admission was twice as likely in males and four times more likely in patients >75 years old and those taking multiple anti-platelet/coagulant therapy (P < 0.05). Blood product transfusion was required in 172 patients (34.5%), specialist investigations in 230 (46.2%) and therapeutic intervention in 51 (10.2%) (surgery in 24 [4.8%]; endoscopic haemostasis in 20 [4.0%] and angiographic embolisation in 9 [1.8%] patients).

Conclusion

ALGIH accounts for 1% of all ED presentations, with half requiring hospital admission. Mortality and surgical intervention rates are low and although most patients can be managed supportively, access to interventional radiology/endoscopy is important.

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Author information

Authors and Affiliations

  1. Academic Colorectal Unit, Sydney Medical School, University of Sydney, Hospital Road, Concord, NSW, Australia

    Kheng-Seong Ng, Deanne Soares, Patrick Stewart & Marc A. Gladman

  2. Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia

    Natasha Nassar

  3. Adelaide Medical School, Faculty of Health & Medical Sciences, The University of Adelaide, Medical School South, Frome Road, Adelaide, 5005, Australia

    Marc A. Gladman

Authors
  1. Kheng-Seong Ng
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  2. Natasha Nassar
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  3. Deanne Soares
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  4. Patrick Stewart
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  5. Marc A. Gladman
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Contributions

• Dr. Kheng-Seong Ng was involved in study design, data collection, analysis and interpretation and writing and reviewing the final manuscript.

• Professor Natasha Nassar was involved in study design, data analysis and interpretation and review of the final manuscript.

• Dr. Deanne Soares was involved in data collection and analysis and review of the final manuscript.

• Dr. Patrick Stewart was involved in data collection and analysis and review of the final manuscript.

• Prof. Marc Gladman was responsible for study conception/design, data interpretation and review of the final manuscript.

Corresponding author

Correspondence to Marc A. Gladman.

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Conflict of interest

No conflicts of interest exist. KSN is supported by NHMRC Postgraduate and Royal College of Surgeons Foundation of Surgery Research Scholarships. NN is supported by an Australian National Health and Medical Research Council (NHMRC) Career Development Fellowship (no. 632955).

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Ng, KS., Nassar, N., Soares, D. et al. Acute lower gastrointestinal haemorrhage: outcomes and risk factors for intervention in 949 emergency cases. Int J Colorectal Dis 32, 1327–1335 (2017). https://doi.org/10.1007/s00384-017-2844-2

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