Fok Kar Yin, Murugesan Jothi R, Maher Richard, Engel Alexander
Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2019 Apr;89(4):E113-E116. doi: 10.1111/ans.15149. Epub 2019 Mar 18.
Haematochezia or per rectal (PR) bleeding is the most common presentation of lower gastrointestinal bleeding. This study analyses the hospital resources used in the management of patients with PR bleeding.
A retrospective analysis was performed on patients who presented with PR bleeding from June 2012 to December 2013 to a single tertiary centre in Sydney, Australia. Age, gender, comorbidities, use of antiplatelet or anticoagulant medications, vital signs, and haematological data were recorded. The objective factors available on initial patient assessment were analysed for their relationship with the following outcomes: use of computed tomography mesenteric angiogram, formal angiography and embolization, transfusion of blood products, endoscopy, operative management and length of stay.
There were 523 confirmed presentations of PR bleeding. Four hundred and fifty-two of these presented directly to emergency department, while 71 were referred from another hospital. One in five patients had blood transfusion (19%), 13% had computed tomography mesenteric angiogram, 4% had embolization and 13% underwent diagnostic and/or therapeutic colonoscopy. Patients referred from other facilities were more comorbid (55% versus 30%), more likely to be on antiplatelet or anticoagulant (69% versus 33%) with a higher rate of embolization (28% versus 4%), more packed cell transfusions (2.1 versus 0.7 units) and longer length of stay (7.9 versus 5.7 days) but mortality was the same (1%).
The management of patients with PR bleeding is resource intensive. Better identification and allocation of resources in patients who present with PR bleeding may lead to better efficiency in managing this growing clinical problem.
便血或直肠指检（PR）出血是下消化道出血最常见的表现。本研究分析了PR出血患者管理中所使用的医院资源。
对2012年6月至2013年12月在澳大利亚悉尼一家三级中心就诊的PR出血患者进行回顾性分析。记录年龄、性别、合并症、抗血小板或抗凝药物的使用情况、生命体征和血液学数据。分析初始患者评估时可获得的客观因素与以下结局的关系：计算机断层扫描肠系膜血管造影、正式血管造影和栓塞、血液制品输注、内镜检查、手术治疗和住院时间。
共有523例确诊的PR出血病例。其中452例直接到急诊科就诊，71例从其他医院转诊而来。五分之一的患者接受了输血（19%），13%接受了计算机断层扫描肠系膜血管造影，4%接受了栓塞，13%接受了诊断性和/或治疗性结肠镜检查。从其他机构转诊来就诊的患者合并症更多（55%对30%），更可能使用抗血小板或抗凝药物（69%对33%），栓塞率更高（28%对4%），浓缩红细胞输注量更多（2.1单位对0.7单位），住院时间更长（7.9天对5.7天），但死亡率相同（1%）。
PR出血患者的管理资源密集。更好地识别和分配PR出血患者的资源可能会提高管理这一日益增长的临床问题的效率。
