When to discharge patients with bleeding peptic ulcers : a prospective study of residual risk of rebleeding.
From January 1993 to December 1994, we conducted a prospective study to investigate the evolutionary change of rebleeding risk in bleeding peptic ulcers.
To obviate possible confounding factors that would influence decision making for discharge of patients, subjects with coexistent acute illnesses, systemic bleeding disorders, alcoholism, and use of nonsteroidal anti-inflammatory drugs were excluded.
Emergency endoscopies were performed in patients with hematemesis or a melena within 24 hours of admission.
Ulcer lesions were divided into six categories according to endoscopic findings.
The residual risks of rebleeding of each type of ulcers were calculated for 10 days, and the critical point of acceptable rebleeding risk after discharge was set at 3%. Results : Three hundred ninety-two patients with bleeding peptic ulcers completed the study.
The ulcers, characterized by clean bases, red or black spots, adherent clots, nonbleeding visible vessels without local therapy, nonbleeding visible vessels with local therapy, and bleeding visible vessels with local therapy took 0,3,3,4,4, and 3 days, respectively, to decrease rebleeding risk to below the critical point.
All episodes of fatal rebleeding (n=4) occurred within 24 hours after admission.
Patients with clean-based ulcers can be discharged in the first day of admission. (...)
Mots-clés Pascal : Ulcère, Gastroduodénal, Complication, Hémorragie, Gastrointestinal, Critère décision, Durée phase, Surveillance, Etude statistique, Homme, Appareil digestif pathologie, Estomac pathologie, Intestin pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie
Mots-clés Pascal anglais : Ulcer, Gastroduodenal, Complication, Hemorrhage, Gastrointestinal, Decision criterion, Phase time, Surveillance, Statistical study, Human, Digestive diseases, Gastric disease, Intestinal disease, Cardiovascular disease, Vascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0493585
Code Inist : 002B24E06. Création : 10/04/1997.