P2546 - Performance Characteristics of High Volume Tertiary Centers in the Evaluation and Management of Suspected Upper Gastrointestinal Bleeding

Tala Mahmoud, MD¹, Muhammad Haseeb, MD², Nayantara Coelho-Prabhu, MD¹, David H. Bruining, MD¹, Louis Wong Kee Song, MD¹, Cadman L. Leggett, MD¹, Navtej Buttar, MD³, Mark V. Larson, MD¹, Barham K. Abu Dayyeh, MD, MPH¹, Michele B. Ryan, MS², Christopher C. Thompson, MD, MSc, FACG², Andrew C. Storm, MD^3
1Mayo Clinic, Rochester, MN; ²Brigham & Women's Hospital, Boston, MA; ³Mayo Clinic College of Medicine, Rochester, MN

Introduction: Upper gastrointestinal (GI) bleeding is a common medical emergency with a 10% mortality rate. Proper evaluation and management of upper GI bleeding is imperative for decreasing mortality and improving outcomes. Current consensus recommends endoscopy within 24 hours of presentation for patients with upper GI bleeding. Therefore, we aimed to assess the performance characteristics of two tertiary care academic centers to optimize management and guide future approaches.

Methods: We conducted a retrospective review of consecutive patients presenting to the emergency department at two tertiary care academic centers for suspected upper GI bleeding between January 2019 and June 2021.

Results: A total of 190 patients (mean age 66.5 ± 16.2, 57% males) were included. Baseline and outcome characteristics are described in Table 1. Presenting symptoms included melena (66.8%), hematemesis (28.9%), and coffee ground emesis (4.2%). One hundred and fifty-eight patients (83.2%) were admitted to the floor and thirty-two patients (16.8%) were admitted to the intensive care unit (ICU), with a median time to admission of 3.5 hours (interquartile range (IQR): 2.2-5.1 hours). Time to first gastroenterologic evaluation and esophagogastroduodenoscopy (EGD) were 15.1 hours (IQR: 6.3-23.3 hours) and 24.2 hours (IQR: 17.2-41.6 hours), respectively. Patients most commonly underwent gastroenterologic evaluation from 6:00 am to 5:59 pm, and EGD from 12:00 pm to 5:59 pm. Hemostatic treatment during EGD was required in 31.6% of patients. Blood transfusions were required in 63% of patients, with a median of 1 transfused unit (interquartile range (IQR): 1-2.25 units) and median time to transfusion of 7.3 hours (IQR: 1.8-15.2 hours). Median time to discharge was 91.7 hours (IQR: 54.6-146.8 hours). Twenty-three patients (12.1%) required readmission within 30 days for recurrence of upper GI bleeding.

Discussion: In this retrospective study, our data demonstrated a favorable time to evaluation and intervention, with a median time to EGD falling within current consensus recommendations. Ensuring early evaluation and intervention is crucial for improving outcomes and mitigating readmission rates of patients with upper GI bleeding. Ideally, future interventions will assist in triage of patients with ongoing or active bleeding in order to prioritize and shorten their time to intervention.



Disclosures:


Tala Mahmoud, MD¹, Muhammad Haseeb, MD², Nayantara Coelho-Prabhu, MD¹, David H. Bruining, MD¹, Louis Wong Kee Song, MD¹, Cadman L. Leggett, MD¹, Navtej Buttar, MD³, Mark V. Larson, MD¹, Barham K. Abu Dayyeh, MD, MPH¹, Michele B. Ryan, MS², Christopher C. Thompson, MD, MSc, FACG², Andrew C. Storm, MD³. P2546 - Performance Characteristics of High Volume Tertiary Centers in the Evaluation and Management of Suspected Upper Gastrointestinal Bleeding, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.