Abstract No. 164 Influence of emergency department clinical presentation on speed of diagnosis for patients with suspected acute gastrointestinal bleeding

Abstract

In patients with suspected acute gastrointestinal bleeding rapid diagnosis is essential to avoid significant morbidity and mortality. The purpose of this study was to assess whether initial clinical evaluation is associated with differences in time between emergency department (ED) presentation and computed tomography angiography (CTA). A retrospective, single health system, multi-hospital study reviewed charts from 2009 to 2019 for patients admitted to the ED with suspected GI bleeding and subsequent CTA. 81 patients with active extravasation on CTA were matched to 93 patients by age, gender and date of CTA scan without active extravasation. Presenting symptoms, vitals, medications, time of ED arrival and CTA were collected. Mean time from ED arrival to CTA was compared using unpaired t-tests. The mean patient age was 69.5 (range, 24-100) and 91 were female. Faster time from admission to CTA was noted in patients on anticoagulation (315 vs 377 mins; P = 0.008) and with heart rate >100 beats/min (314 vs 378 mins; P< 0.001). Hematochezia (330 vs 435 minutes; P = 0.057) was non-significant but trended toward faster time to CTA. No difference was noted based on systolic blood pressure < 110 mmHg (362 vs 343 mins; P = 0.79). Overall, time from ED admission to CTA was significantly faster in patients with active extravasation (297 vs 423 minutes; P = .009). In patients with suspected gastrointestinal bleeding accurate clinical assessment drives faster time to confirmation of hemorrhage on CTA.