TRIAGE CONSIDERATIONS FOR PATIENTS WITH ACUTE GASTROINTESTINAL HEMORRHAGE ADMITTED TO A MEDICAL INTENSIVE-CARE UNIT

Objective: To determine whether previously identified clinical criteria, available at the time of triage, can predict clinical outcomes for patients with acute gastrointestinal (GI) hemorrhage. Design: An inception cohort study. Setting: Barnes Hospital, an academic tertiary care center. Patients: One hundred eight consecutive hospital admissions (103 patients) triaged to intensive care for GI hemorrhage. Interventions: Prospective patient surveillance, data collection, and risk stratification using preselected clinical criteria and outcomes assessment. Measurements and Main Results: Using clinical data available at the time of triage, 28 (25.9%) intensive care unit admissions were classified as low risk for having poor outcomes. There was no difference in the distribution of upper and lower GI tract sources of hemorrhage for the two risk groups (p =.310), Stigmata of recent hemorrhage were endoscopically identified for six (21.4%) of the low-risk patient admissions and for 16 (20.0%) of the high-risk patient admissions (p =.872). Patient admissions identified as low risk had significantly lower rates of recurrent GI hemorrhage (3.6% vs. 22.5%; p = .022), less acquired organ system derangements (1.0 +/- 0.3 vs. 1.5 +/- 1.0 organs; p < .001), shorter lengths of hospitalization (4.9 +/- 3.5 vs. 8.8 +/- 7.4 days; p < .001), required transfusion with fewer units of packed red blood cells (1.3 +/- 1.2 vs. 6.2 +/- 4.7 units; p < .001), and had a lower overall hospital mortality rate (0.0% vs. 21.3%; p = .008) compared with patient admissions identified as being high risk. Conclusion: These data suggest that objective clinical criteria, available at the time of triage determination, can be utilized to identify a low-risk group of patients with acute GI hemorrhage, having favorable outcomes and potentially no need for intensive care unit services.