Profile and outcome of adult patients presenting to the emergency medicine department with upper gastrointestinal bleeding

Abstract

ABSTRACT Background: Upper Gastrointestinal Bleeding (UGIB) is a common Emergency Department (ED) presentation with high morbidity and mortality. There is a paucity of data on the profile and outcome of patients who present with UGIB in emergency situations, especially within limited resource settings. We aimed to determine the profile and outcome of adult patients who present to the emergency department of a national referral hospital in a limited resource setting with UGIB. Methods: This was a prospective cohort study of adult (≥18 years) patients presenting to the Emergency Departments of Muhimbili National Hospital (EMD-MNH) and MUHAS Academic Medical Centre (EMD-MAMC), in Dar-es-Salaam, Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July to December 2018. Patient demographic data, clinical presentation, severity and ED management provided were recorded. We used the clinical Rockall score to assess disease severity. The primary outcome of mortality was summarized using descriptive statistics. Regression analysis was performed to identify predictors of 7-day mortality. Results: We screened 31987 patients, and included 123 (0.4%) patients with UGIB. Overall the median age was 42 years (IQR 32-64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). PUD was the most frequently reported comorbidity 39 (40.2%). A median Clinical Rockall score of 3 was observed with most patients ranging between scores of 3-4 (51.2%). Mortality occurred in 23 (18.7%). Age >40 years was a significant predictor of mortality (OR=7.00(1.9-26.4), p=0.004). Receiving UGI endoscopy significantly reduced the risk of mortality (OR= 0.273(0.08-0.9), p=0.047). Conclusion: In this urban ED in Sub-Saharan Africa over half of patients with UGIB did not receive endoscopy during the current presentation. UGIB carried a high mortality rate among these patients, and age above 40 years, and endoscopic evaluation at any point during the hospital are independent predictor of mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy so as to improve outcomes.