上消化道出血的拟议风险分层：住院治疗必不可少吗？
Proposed risk stratification in upper gastrointestinal haemorrhage: is hospitalisation essential?
作者信息
Courtney A E, Mitchell R M S, Rocke L, Johnston B T
机构信息
Department of Gastroenterology, Royal Victoria Hospital, Belfast, UK.
出版信息
Emerg Med J. 2004 Jan;21(1):39-40. doi: 10.1136/emj.2003.012328.
AIMS
Patients with upper gastrointestinal haemorrhage (UGIH) are usually admitted to hospital regardless of the severity of the bleed. The aim of this study was to identify patients who could be safely managed without hospitalisation and immediate inpatient endoscopy.
METHODS
Based on a literature review, a protocol was devised using clinical and laboratory data regarded as being of prognostic value. A retrospective observational study of consecutive patients who attended the emergency department (ED) with UGIH was conducted during one calendar month.
RESULTS
Fifty four patients were identified of whom 44 (81%) were admitted. Twelve suffered an adverse event. One of the 10 patients (10%) initially discharged from the ED was later admitted. Strict implementation of the protocol would have resulted in safe discharge of a further 15 patients, (34% of those admitted), and a saving of an estimated 37 bed days per month.
CONCLUSIONS
Patients at low risk from UGIH may be identified in the ED. If validated, this protocol may improve patient management and resource utilisation.
目的
上消化道出血（UGIH）患者通常无论出血严重程度如何都会住院治疗。本研究的目的是确定那些无需住院和立即进行住院内镜检查即可安全管理的患者。
方法
在文献综述的基础上，利用被认为具有预后价值的临床和实验室数据制定了一份方案。对在一个日历月内因UGIH到急诊科（ED）就诊的连续患者进行了一项回顾性观察研究。
结果
共确定了54例患者，其中44例（81%）住院。12例发生不良事件。最初从急诊科出院的10例患者中有1例（10%）后来再次住院。严格执行该方案可使另外15例患者（占住院患者的34%）安全出院，估计每月节省37个床位日。
结论
在急诊科可识别出UGIH低风险患者。如果得到验证，该方案可能会改善患者管理和资源利用。
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