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Profile and outcome of patients with upper gastrointestinal bleeding presenting to urban emergency departments of tertiary hospitals in Tanzania.
BMC Gastroenterol. 2019 Dec 10; 19(1):212.BG

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 to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania.

METHODS

This was a prospective cohort study of consecutive adult (≥18 years) patients presenting to the EDs of Muhimbili National Hospital (ED-MNH) and MUHAS Academic Medical Centre (ED-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. Patient demographic data, clinical presentation, and ED and hospital management provided were recorded. We used the clinical Rockall score to assess disease severity. The primary outcome of 7- day mortality was summarized using descriptive statistics. Regression analysis was performed to identify predictors of mortality.

RESULTS

During the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42 years (Interquartile range (IQR) 32-64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7 days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24 h. There were no ED deaths. About 65.1% of the patients had severe anemia but only 60 (48.8%) received blood transfusion in the ED. Amongst those with history of (h/o) esophageal varices 7(41.2%) did not receive octreotide. Upper GI endoscopy, was performed on 46 (37.4%) patients, of whom only 8 (17.4%) received endoscopy within 24 h (early UGI endoscopy). All patients who received early UGI endoscopy had a low or moderate clinical Rockall score i.e. < 3 and 3-4. No patient with scores of > 4 received early UGI endoscopy. Age > 40 years was a significant independent predictor of mortality (OR = 7.00 (95% CI 1.7-29.2). Having a high clinical Rockall score of ≥ 4 was a significant independent predictor of mortality (OR = 6.4 (95% CI 1.8-22.8).

CONCLUSIONS

In this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age > 40 years and clinical Rockall score ≥ 4 were independent predictors of higher mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy so as to improve outcomes.

Authors+Show Affiliations

Emergency Medicine Department, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania.Emergency Medicine Department, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania. hendry_sawe@yahoo.com. Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania. hendry_sawe@yahoo.com.Emergency Medicine Department, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania.Emergency Medicine Department, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania.Critical Care Unit, Regency Medical Centre, Dar es Salaam, Tanzania.Emergency Medicine Department, Muhimbili University of Health and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania. Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania. Department of Emergency Medicine, University of California, San Francisco, CA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31823741

Citation

Rajan, Shaffin S., et al. "Profile and Outcome of Patients With Upper Gastrointestinal Bleeding Presenting to Urban Emergency Departments of Tertiary Hospitals in Tanzania." BMC Gastroenterology, vol. 19, no. 1, 2019, p. 212.
Rajan SS, Sawe HR, Iyullu AJ, et al. Profile and outcome of patients with upper gastrointestinal bleeding presenting to urban emergency departments of tertiary hospitals in Tanzania. BMC Gastroenterol. 2019;19(1):212.
Rajan, S. S., Sawe, H. R., Iyullu, A. J., Kaale, D. A., Olambo, N. A., Mfinanga, J. A., & Weber, E. J. (2019). Profile and outcome of patients with upper gastrointestinal bleeding presenting to urban emergency departments of tertiary hospitals in Tanzania. BMC Gastroenterology, 19(1), 212. https://doi.org/10.1186/s12876-019-1131-9
Rajan SS, et al. Profile and Outcome of Patients With Upper Gastrointestinal Bleeding Presenting to Urban Emergency Departments of Tertiary Hospitals in Tanzania. BMC Gastroenterol. 2019 Dec 10;19(1):212. PubMed PMID: 31823741.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Profile and outcome of patients with upper gastrointestinal bleeding presenting to urban emergency departments of tertiary hospitals in Tanzania. AU - Rajan,Shaffin S, AU - Sawe,Hendry R, AU - Iyullu,Asha J, AU - Kaale,Dereck A, AU - Olambo,Nancy A, AU - Mfinanga,Juma A, AU - Weber,Ellen J, Y1 - 2019/12/10/ PY - 2019/07/26/received PY - 2019/11/28/accepted PY - 2019/12/12/entrez PY - 2019/12/12/pubmed PY - 2019/12/12/medline KW - Emergency department KW - Non-traumatic patients KW - Sub Saharan Africa. KW - Tanzania KW - Upper gastrointestinal bleeding SP - 212 EP - 212 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 19 IS - 1 N2 - 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 to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania. METHODS: This was a prospective cohort study of consecutive adult (≥18 years) patients presenting to the EDs of Muhimbili National Hospital (ED-MNH) and MUHAS Academic Medical Centre (ED-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. Patient demographic data, clinical presentation, and ED and hospital management provided were recorded. We used the clinical Rockall score to assess disease severity. The primary outcome of 7- day mortality was summarized using descriptive statistics. Regression analysis was performed to identify predictors of mortality. RESULTS: During the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42 years (Interquartile range (IQR) 32-64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7 days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24 h. There were no ED deaths. About 65.1% of the patients had severe anemia but only 60 (48.8%) received blood transfusion in the ED. Amongst those with history of (h/o) esophageal varices 7(41.2%) did not receive octreotide. Upper GI endoscopy, was performed on 46 (37.4%) patients, of whom only 8 (17.4%) received endoscopy within 24 h (early UGI endoscopy). All patients who received early UGI endoscopy had a low or moderate clinical Rockall score i.e. < 3 and 3-4. No patient with scores of > 4 received early UGI endoscopy. Age > 40 years was a significant independent predictor of mortality (OR = 7.00 (95% CI 1.7-29.2). Having a high clinical Rockall score of ≥ 4 was a significant independent predictor of mortality (OR = 6.4 (95% CI 1.8-22.8). CONCLUSIONS: In this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age > 40 years and clinical Rockall score ≥ 4 were independent predictors of higher mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy so as to improve outcomes. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/31823741/Profile_and_outcome_of_patients_with_upper_gastrointestinal_bleeding_presenting_to_urban_emergency_departments_of_tertiary_hospitals_in_Tanzania_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-019-1131-9 DB - PRIME DP - Unbound Medicine ER -