UPPER GASTROINTESTINAL-BLEEDING - SYNDROM IC DIAGNOSIS IN A HOSPITAL EMERGENCY UNIT

BACKGROUND: TO analyze the assistance requirements generated in a hosp ital emergency unit by the upper gastrointestinal bleeding (UGIB) synd rome, and to assess some strategies intended to improve its syndromic diagnosis prior to admission. PATIENTS AND METHODS: Prospective study of a cohort including 1,029 consecutive cases assisted because of pres umed hematemesis or melenas. At the emergency room UGIB was diagnosed or ruled out according to criteria based on examination of vomits and stools. Those cases not classified were observed before establishing t he preadmission diagnosis. Sensitivity (Se), specificity (Sp) and like lihood ratio for a positive or negative test were estimated in each st ep of the process. The efficacy of the proposed criteria for diagnosis was compared with those accepted by the World Organization of Gastroe nterology (WOG). The diagnosis at hospital discharge was used a refere nce pattern. RESULTS: A final diagnosis of UGIB was established in 718 cases (59%). The emergency room criteria were applicated to 848 out o f the 1,029 patients assisted, bleeding being discarded in 216 cases ( Se = 0.43; Sp = 0.99) and estimated as present in 632 (Se = 0.79%; Sp = 0.87%), By combining these results with those obtained after observa tion of the remaining 361 patients, the preadmission diagnosis showed a sensitivity of 0.99% and a specificity of 0.86%, Should the WOG crit eria were adopted, the same process was equally sensitive but less spe cific (Sp=0.55%). CONCLUSIONS: In a high proportion of patients assist ed in a hospital for a suspected UGIB, this diagnosis is not confirmed . The examination of vomits and stools by nursing or medical satff, fo llowed if needed by an observation period, improves the accuracy of th e syndromic diagnosis prior to admission and may avoid an elevated num ber of unnecessary hospital staying.