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Predictors of Clinically Significant Upper Gastrointestinal Hemorrhage Among Children With Hematemesis
Journal of Pediatric Gastroenterology and Nutrition, 05/17/2012
Freedman SB et al. – The occurrence of a clinically significant upper gastrointestinal hemorrhage (UGIH) was uncommon among children with hematemesis, especially in well–appearing children without melena, hematochezia, or who had not vomited a moderate to large amount of fresh blood.
Methods- A retrospective cohort study was conducted.
- All of the emergency department visits by children ages 0 to 18 years who presented with hematemesis between 2000 and 2007 were reviewed.
- The primary aim of the study was to determine the proportion of children who developed a clinically significant UGIH; the secondary aim was to identify risk factors predictive of a clinically significant UGIH.
- A significant UGIH was defined by any of the following: hemoglobin drop >20g/L, blood transfusion, or emergent endoscopy or surgical procedure.
- Twenty-seven of 613 eligible children (4%; 95% confidence interval 3%–6%) had a clinically significant UGIH.
- The frequency of laboratory investigations increased with age (P<0.001).
- The hemoglobin level was the only laboratory investigation whose results differed between those with and without significant bleeds.
- The presence of any one of the following characteristics identified all of the children with a clinically significant hemorrhage: melena, hematochezia, unwell appearance, or a moderate to large volume of fresh blood in the vomitus, sensitivity 100% (95% confidence interval 85%–100%).