New York Presbyterian - Weill Cornell Medical Center New York, NY, United States
Sunena Tewani, MD1, Tracey Martin, MD1, Lindsay Clarke, MD1, Aiya Aboubakr, MD2, Srikanth Palanisamy, MD3, Jihui Lee, PhD1, Carl Crawford, MD1, David Wan, MD4 1Weill Cornell Medical College, New York, NY; 2New York Presbyterian-Weill Cornell Medical Center, New York, NY; 3Stanford University School of Medicine, New York, NY; 4New York Presbyterian Weill Cornell Medicine, New York, NY
Introduction: Acute lower gastrointestinal bleeding (ALGIB) is a common reason for hospital admission, yet recent data suggests that low-risk (i.e. hemodynamically stable) patients may be safely evaluated in the outpatient setting, reducing hospital length of stay and related healthcare costs. Practice guidelines on which patients to discharge from the ED for outpatient evaluation and timing of follow up evaluation are not well established. In this study, we aim to determine distinct characteristics and predictors of stable LGIB patients who are discharged from the ED compared to those admitted.
Methods: This was a retrospective cohort study of 97 patients with stable LGIB presenting to the ED at an academic tertiary care center in New York City, between November 1, 2018 and October 31, 2019. Patients included had a chief complaint or primary diagnosis of rectal bleeding, clinical evidence of lower GIB (visible hematochezia or maroon stools on exam) and hemodynamic stability defined as a systolic blood pressure ≥100 mmHg or heart rate ≤100 beats/minute on presentation. Admission or Discharge status was characterized and therapeutic and 30-day outcomes including rebleeding, readmission, and mortality were compared between both groups. Rates of outpatient follow up were determined in the discharged cohort.
Results: Of the 97 patients presenting with stable LGIB, 62% were admitted and 38% were discharged. Factors significant associated with discharge included: age (p< 0.001), lack of aspirin (p< 0.002) and anticoagulation (p< 0.004) use, higher index hemoglobin (p< 0.001) and albumin (p< 0.001), lower BUN (p< 0.001) and creatinine (Cr) (p=0.001), lower Oakland score (p< .001), lower Charlson Comorbidity Index (CCI) (p< 0.001) and lack of transfusion requirements. There was no significant difference in 30-day rebleeding, readmission or mortality rates between both groups. Discharged patients had a 46% outpatient follow up rate, with 42% occurring within 30 days of index bleed.
Discussion: In hemodynamically stable patients presenting to an emergency room with LGIB and no other indication for hospital admission, there is considerable uncertainty regarding the optimal setting for management (i.e. inpatient admission versus outpatient discharge). While early discharge in low-risk LGIB patients appears to be safe, further prospective studies are needed to guide risk stratification and determine optimal timing for outpatient evaluation.
Disclosures: Sunena Tewani indicated no relevant financial relationships. Tracey Martin indicated no relevant financial relationships. Lindsay Clarke indicated no relevant financial relationships. Aiya Aboubakr indicated no relevant financial relationships. Srikanth Palanisamy indicated no relevant financial relationships. Jihui Lee indicated no relevant financial relationships. Carl Crawford indicated no relevant financial relationships. David Wan indicated no relevant financial relationships.
Sunena Tewani, MD1, Tracey Martin, MD1, Lindsay Clarke, MD1, Aiya Aboubakr, MD2, Srikanth Palanisamy, MD3, Jihui Lee, PhD1, Carl Crawford, MD1, David Wan, MD4. P2558 - Comparison of Characteristics and Outcomes in Discharged versus Admitted Patients Presenting to the Emergency Room with Low Risk Lower Gastrointestinal Bleeding, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.