Selective outpatient management of upper gastrointestinal bleeding in the elderly.
We sought to determine whether elderly patients with upper gastrointestinal bleeding can be safely managed as outpatients.
We were also interested in determining the etiology of bleeding peptic ulcer disease in this population.
Eighty-four patients (65 yr of age and older) were studied during a 23-month period.
Urgent outpatient endoscopy was performed and clinical as well as endoscopic criteria were applied to determine the need for hospital admission.
Patients with endoscopic findings that indicated a low risk for rebleeding were not admitted if they lacked one major or three minor predefined clinical criteria.
All enrollees were followed after discharge from the clinic or hospital for 4 wk with hematocrit determination and clinical assessments.
The main outcome measures were the number of patients who met our predefined clinical and endoscopic criteria for outpatient versus inpatient care and the differences in the rebleeding rates in these two groups.
Twenty-four (29%) patients were treated as outpatients ; none rebled.
In contrast, seven (12%) of the 60 inpatients had one or more rebleeding episodes (p=0.002).
Bleeding from peptic ulcer disease was associated with use of nonsteroidal antiinflammatory medications in 81% of patients.
Selective outpatient management of elderly patients with upper gastrointestinal bleeding can be done safely and has the potential to lead to reduced health care expenditures. (...)
Mots-clés Pascal : Hémorragie, Gastrointestinal, Indication, Traitement, Ambulatoire, Coût, Sécurité, Efficacité traitement, Personne âgée, Homme, Appareil digestif pathologie, Estomac pathologie, Intestin pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Economie santé
Mots-clés Pascal anglais : Hemorrhage, Gastrointestinal, Indication, Treatment, Ambulatory, Costs, Safety, Treatment efficiency, Elderly, Human, Digestive diseases, Gastric disease, Intestinal disease, Cardiovascular disease, Vascular disease, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0278917
Code Inist : 002B13B03. Création : 16/11/1999.