04:03 PM Abstract No. 245 Impact of vital signs and delay following positive diagnostic imaging in predicting positive angiogram for gastrointestinal hemorrhage

Abstract

To evaluate the utility of vital signs and delay between positive diagnostic imaging and angiogram in predicting active extravasation on angiogram in patients with GI hemorrhage. A single-institution retrospective chart review identified patients with GI bleeding over a 10-year period. Vital signs in the 4 hours preceding angiogram, diagnostic studies, and angiographic studies were reviewed. Variables were compared using univariate statistics. A total of 272 patients were identified. Of the 384 total angiograms, 109 were performed after a positive diagnostic imaging study. Mean time from diagnostic imaging completion to the start of angiogram was 124 ± 77 minutes for positive angiograms and 191 ± 105 minutes for negative angiograms (p=0.001). Angiograms performed < 2 hours after positive imaging were positive for active hemorrhage in 22/41 (54%) patients, while those performed >2 hours after imaging were positive in only 13/68 (19%) patients. Vital signs in the 4 hours prior to the angiogram were available for 198/384 angiograms and are compared between patients with positive and negative angiograms in the table. While all are statistically significantly different between groups, this is likely of little clinical significance given the similar absolute values. The intermittent nature of GI hemorrhage results in a high rate of negative angiograms. Minimizing delays between positive diagnostic imaging and angiogram increased the likelihood of visualizing a culprit vessel to be targeted for treatment. Though vital signs were statistically different between patients with positive and negative angiograms, the clinical significance of these differences is questionable as no vital sign appears to reliably identify patients with subsequent positive angiogram.Tabled 1Positive AngiogramNegative AngiogramP ValueHR at angiogram start92.1 ± 17.785.2 ± 18.50.009BP at angiogram start122.9 ± 23.9139.7 ± 26.1<0.00166.8 ± 12.472.4 ± 13.10.003Maximum HR106.3 ± 20.297.2 ± 20.70.002Minimum BP97.9 ± 24.5111.8 ± 25.7<0.00155.8 ± 12.260.4 ± 12.30.01 Open table in a new tab