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.
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%).
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