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June 14, 1985

Early Clinical Signs Identify Low-Risk Patients With Acute Upper Gastrointestinal Hemorrhage

Author Affiliations

From the Divisions of General Internal Medicine, Department of Medicine, University of Rochester (NY) School of Medicine and Dentistry, Rochester General Hospital (Drs Bordley, Dolan, and Richardson); and Strong Memorial Hospital (Drs Mushlin, Barry, Polio, and Griner), New York. Dr Barry is now with the Department of General Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, and Dr Polio is now with the Department of Gastroenterology, Yale-New Haven (Conn) Medical Center.

JAMA. 1985;253(22):3282-3285. doi:10.1001/jama.1985.03350460082026

Early identification of patients at low risk for poor outcome after acute upper gastrointestinal hemorrhage would allow reduction of diagnostic and therapeutic interventions. We identified six early predictors of good outcome: age less than 75 years, no unstable comorbid illness, no ascites found on physical examination, normal prothrombin time, and, within an hour after presentation, systolic blood pressure of 100 mm Hg or greater and nasogastric aspirate free of fresh blood. Presence of all six predictors defined the low-risk population. Among 162 patients in the development and retrospective validation phases of our study, all 74 low-risk patients had good outcomes. A prospective validation study of 111 patients further established the accuracy of our predictive method; only two of 52 low-risk patients had poor outcomes. Application of our method should allow more selective management of patients with acute upper gastrointestinal hemorrhage.

(JAMA 1985;253:3282-3285)