Copyright
©The Author(s) 2017.
World J Gastroenterol. Mar 7, 2017; 23(9): 1608-1617
Published online Mar 7, 2017. doi: 10.3748/wjg.v23.i9.1608
Published online Mar 7, 2017. doi: 10.3748/wjg.v23.i9.1608
Table 1 Patient characteristics by principal and secondary diagnosis of gastrointestinal bleeding n (%)
| GI bleed | Overall (n = 19528) | P value | ||
| Principal Dx (n = 6733) | Secondary Dx (n = 12795) | |||
| Age in years (IQR) | 10 (4, 15) | 9 (4, 15) | 9 (4, 15) | < 0.0001 |
| Gender | < 0.0001 | |||
| Female | 2925 (43.44) | 5941 (46.43) | 8866 (45.40) | |
| Male | 3808 (56.56) | 6854 (53.57) | 10762 (55.11) | |
| Race | < 0.0001 | |||
| Non-Hispanic White | 3608 (53.59) | 6596 (51.55) | 10204 (52.25) | |
| Non-Hispanic Black | 1180 (17.53) | 2257 (17.64) | 3437 (17.60) | |
| Hispanic | 1159 (17.21) | 2580 (20.16) | 3739 (19.15) | |
| Asian | 251 (3.73) | 332 (2.59) | 583 (2.99) | |
| Other | 412 (6.12) | 779 (6.09) | 1191 (6.10) | |
| Unknown | 123 (1.83) | 251 (1.96) | 374 (1.92) | |
| Urban/rural | 0.1247 | |||
| Urban | 5730 (85.10) | 10930 (85.42) | 16660 (85.31) | |
| Rural | 873 (12.97) | 1573 (12.29) | 2446 (12.53) | |
| Unknown | 130 (1.93) | 292 (2.28) | 422 (2.16) | |
| Complex chronic conditions | < 0.0001 | |||
| 0 | 3767 (55.95) | 5969 (46.65) | 9736 (49.86) | |
| 1-2 | 1771 (26.30) | 4328 (33.83) | 6099 (31.23) | |
| ≥ 3 | 1195 (17.75) | 2498 (19.52) | 3693 (18.91) | |
| GIH symptoms | ||||
| Hematemesis | 2333 (34.65) | 4263 (33.32) | 6596 (33.78) | 0.0635 |
| Melena | 1983 (29.45) | 6018 (47.03) | 8001 (40.97) | < 0.0001 |
| Hypovolemia | 52 (0.77) | 90 (0.70) | 142 (0.73) | 0.5956 |
| Pharmaceutical Interventions | ||||
| PPI on day 0 or 1 | 4473 (66.43) | 6038 (47.19) | 10511 (53.83) | < 0.0001 |
| H2RA on day 0 or 1 | 1301 (19.32) | 2715 (21.22) | 4016 (20.57) | 0.0019 |
| Erythromycin on day 0 or 1 | 197 (2.93) | 313 (2.45) | 510 (2.61) | 0.0511 |
| Vasopressin on day 0 or 1 | 15 (0.22) | 142 (1.11) | 157 (0.80) | < 0.0001 |
| Octreotide on day 0 or 1 | 349 (5.18) | 439 (3.43) | 788 (4.04) | < 0.0001 |
| Diagnostic Imaging | ||||
| Meckel's Scan day 0-2 | 497 (7.38) | 378 (2.95) | 875 (4.48) | < 0.0001 |
| Abdomen CT day 0-2 | 425 (6.31) | 1298 (10.14) | 1723 (8.82) | < 0.0001 |
| Abdomen MRI day 0-2 | 44 (0.65) | 170 (1.33) | 214 (1.10) | < 0.0001 |
| Arteriography day 0-2 | 75 (1.11) | 93 (0.73) | 168 (0.86) | 0.0070 |
| Surgical interventions | ||||
| Laparotomy, exploratory | 23 (0.34) | 44 (0.34) | 67 (0.34) | 0.9999 |
| Laparotomy, other | 2 (0.03) | 19 (0.15) | 21 (0.11) | 0.0191 |
| Laparoscopy | 54 (0.80) | 96 (0.75) | 150 (0.77) | 0.7303 |
| EGD | 2304 (34.22) | 2317 (18.11) | 4621 (23.66) | < 0.0001 |
| Other endoscopy | 845 (12.55) | 845 (6.6) | 1690 (8.65) | < 0.0001 |
| Transcatheter embolization | 8 (0.12) | 8 (0.06) | 16 (0.08) | 0.1977 |
| Ligation, esophag. varices | 0 (0.0) | 5 (0.04) | 5 (0.03) | 0.1719 |
| Ligation, gastric varices | 1 (0.01) | 5 (0.04) | 6 (0.03) | 0.6713 |
| Packed red blood cell transfusions | 1265 (18.79) | 2337 (18.26) | 3602 (18.45) | 0.3808 |
| Platelet transfusions | 194 (2.88) | 799 (6.24) | 993 (5.09) | < 0.0010 |
| ICU stay as part of encounter | 880 (13.07) | 2328 (18.19) | 3208 (16.43) | < 0.0001 |
| Chronic liver disease | 171 (2.54) | 400 (3.13) | 571 (2.92) | 0.0234 |
| GIH present on admit | 4980 (73.96) | 8585 (67.10) | 11084 (56.76%) | < 0.0001 |
| Shock | 144 (2.14) | 584 (4.56) | 728 (3.73) | < 0.0001 |
| Sepsis | 30 (0.45) | 666 (5.21) | 696 (3.56) | < 0.0001 |
| Hospital lOS (IQR) | 2 (1, 4) | 3 (2, 7) | 3 (1, 6) | < 0.0001 |
| Day of EGD | 1 (0, 2) | 2 (1, 3) | 1 (0, 2) | < 0.0001 |
| Mortality | 25 (0.37) | 379 (2.96) | 404 (2.07) | < 0.0001 |
Table 2 Univariate analysis of factors affecting mortality n (%)
| Survived (n = 19124) | Died (n = 404) | Overall (n = 19528) | P value | |
| Age in years (IQR) | 9 (4, 15) | 8 (3, 15) | 9 (4, 15) | 0.2997 |
| Gender | 0.0679 | |||
| Female | 8864 (46.35) | 202 (50) | 9066 (46.43) | |
| Male | 10460 (54.70) | 202 (50) | 10662 (54.60) | |
| Race | 0.0005 | |||
| Non-Hispanic White | 10036 (52.48) | 168 (41.58) | 10204 (52.25) | |
| Non-Hispanic Black | 3358 (17.56) | 79 (19.55) | 3437 (17.60) | |
| Hispanic | 3646 (19.07) | 93 (23.02) | 3739 (19.15) | |
| Asian | 565 (2.95) | 18 (4.46) | 583 (2.99) | |
| Other | 1156 (6.04) | 35 (8.66) | 1191 (6.10) | |
| Unknown | 363 (1.90) | 11 (2.72) | 374 (1.92) | |
| Urban/rural | 0.2524 | |||
| Urban | 16324 (85.36) | 336 (83.17) | 16660 (85.31) | |
| Rural | 2385 (12.47) | 61 (15.10) | 2446 (12.53) | |
| Unknown | 415 (2.17) | 7 (1.73) | 422 (2.16) | |
| Complex chronic conditions | < 0.0001 | |||
| 0 | 9689 (50.66) | 12 (2.97) | 9701 (49.68) | |
| 1-2 | 5825 (30.46) | 95 (23.51) | 5920 (30.32) | |
| ≥ 3 | 3610 (18.88) | 297 (73.51) | 3907 (20.01) | |
| GIH symptoms | ||||
| Hematemesis | 6508 (34.03) | 88 (21.78) | 6596 (33.78) | < 0.0001 |
| Melena | 7899 (41.30) | 102 (25.25) | 8001 (40.97) | < 0.0001 |
| Hypovolemia | 131 (0.69) | 11 (2.72) | 142 (0.73) | 0.0002 |
| GER | 2329 (12.18) | 50 (12.38) | 2379 (12.18) | 0.9653 |
| Pharmaceutical interventions | ||||
| PPI first 24 h | 10234 (53.51) | 277 (68.56) | 10511 (53.83) | < 0.0001 |
| H2RA first 24 h | 3864 (20.20) | 152 (37.62) | 4016 (20.57) | < 0.0001 |
| Erythromycin first 24 h | 480 (2.51) | 30 (7.43) | 510 (2.61) | < 0.0001 |
| Vasopressin first 24 h | 58 (0.30) | 99 (24.50) | 157 (0.80) | < 0.0001 |
| Octreotide first 24 h | 708 (3.70) | 80 (19.80) | 788 (4.04) | < 0.0001 |
| Surgical interventions | ||||
| Laparotomy, exploratory | 54 (0.28) | 13 (3.22) | 67 (0.34) | < 0.0001 |
| Laparotomy, other | 16 (0.08) | 5 (1.24) | 21 (0.11) | < 0.0001 |
| Laparoscopy | 144 (0.75) | 6 (1.49) | 150 (0.77) | 0.1347 |
| EGD | 4569 (23.89) | 52 (12.87) | 4621 (23.66) | < 0.0001 |
| Other endoscopy | 1638 (8.57) | 52 (12.87) | 1690 (8.65) | 0.0031 |
| Transcatheter embolization | 14 (0.07) | 2 (0.50) | 16 (0.08) | 0.0423 |
| Ligation, esophag. varices | 4 (0.02%) | 1 (0.25%) | 5 (0.03) | 0.0993 |
| Ligation, gastric varices | 6 (0.03) | 0 (0.00) | 6 (0.03) | 0.9999 |
| Diagnostic imaging | ||||
| Meckel's Scan day 0-2 | 873 (4.56) | 2 (0.50) | 875 (4.48) | 0.0001 |
| Abdomen CT day 0-2 | 1675 (8.76) | 48 (11.88) | 1723 (8.82) | 0.0356 |
| Abdomen MRI day 0-2 | 212 (1.11) | 2 (0.50) | 214 (1.10) | 0.3340 |
| Arteriography day 0-2 | 163 (0.85) | 5 (1.24) | 168 (0.86) | 0.4031 |
| Packed red blood cell Transfusion | 3361 (17.57) | 241 (59.65) | 3602 (18.45) | < 0.0001 |
| Platelet transfusion | 819 (4.28) | 174 (43.07) | 993 (5.09) | < 0.0001 |
| ICU stay as part of encounter | 2863 (14.97) | 345 (85.40) | 3208 (16.43) | < 0.0001 |
| Chronic liver disease | 536 (2.80) | 35 (8.66) | 571 (2.92) | < 0.0001 |
| GIB Present on admit | 13386 (70.00) | 179 (44.31) | 11084 (56.76) | < 0.0001 |
| Principal Dx GIB | 6708 (35.07) | 25 (6.18) | 6733 (34.48) | < 0.0001 |
| Sepsis | 516 (2.70) | 180 (44.55) | 696 (3.56) | < 0.0001 |
| Shock | 562 (2.94) | 166 (41.09) | 728 (3.73) | < 0.0001 |
| Hospital LOS (IQR) | 3 (1, 6) | 19 (5, 49) | 3 (1, 6) | < 0.0001 |
| Day of EGD | 1 (0, 2) | 3 (1, 14) | 1 (0, 2) | < 0.0001 |
Table 3 Top 10 admitting diagnoses for mortalities and non-mortalities
| ICD-9 code | ICD-9 code description | n (%) |
| Mortalities | ||
| 780.60 | Fever | 32 (7.92) |
| 786.09 | Other dyspnea and respiratory abnormality | 23 (5.69) |
| 787.03 | Vomiting alone | 15 (3.71) |
| 03.89 | Unspecified septicemia | 14 (3.47) |
| 578.0 | Hematemesis | 13 (3.22) |
| 427.5 | Cardiac arrest | 13 (3.22) |
| 578.9 | Hemorrhage of GI tract, unspecified | 12 (2.97) |
| 486.0 | Pneumonia, organism unspecified | 11 (2.72) |
| 288.00 | Diseases of white blood cells | 10 (2.48) |
| 518.81 | Acute respiratory failure | 10 (2.48) |
| Non-mortalities | ||
| 578.0 | Hematemesis | 3058 (15.99) |
| 578.1 | Blood in Stool | 2750 (14.38) |
| 578.9 | Hemorrhage of GI tract, unspecified | 1289 (6.74) |
| 789.00 | Other symptoms involving abdomen and pelvis | 755 (3.95) |
| 787.03 | Vomiting alone | 748 (3.91) |
| N/A | Not available or Missing | 707 (3.70) |
| 780.60 | Fever | 559 (2.92) |
| 276.51 | Dehydration | 515 (2.69) |
| 787.91 | Diarrhea | 500 (2.61) |
| 2859 | Anemia | 292 (1.53) |
Table 4 Complex chronic conditions by principal and secondary diagnosis of gastrointestinal bleeding n (%)
| Principal Dx is GI bleed (n = 4521) | Secondary Dx is GI bleed (n = 15007) | P value | |
| GI flag | 1681 (24.39) | 3892 (15.39) | < 0.0001 |
| Cardiovascular flag | 513 (7.44) | 1192 (4.71) | < 0.0001 |
| Hem/immunologic flag | 422 (6.12) | 1392 (5.5) | < 0.0001 |
| Malignancy | 284 (4.12) | 1015 (4.01) | < 0.0001 |
| Metabolic flag | 258 (3.74) | 1015 (4.01) | < 0.0001 |
| Neurologic/neuromusc flag | 972 (14.1) | 1743 (6.89) | 0.1234 |
| Congenital/genetic flag | 727 (10.55) | 1192 (4.71) | 0.0010 |
| Renal/urologic flag | 249 (3.61) | 811 (3.21) | < 0.0001 |
| Respiratory flag | 244 (3.54) | 601 (2.38) | 0.0005 |
| Technology depend flag | 1353 (19.63) | 2599 (10.28) | 0.7331 |
| Transplant flag | 318 (4.61) | 578 (2.29) | 0.5374 |
Table 5 Complex chronic conditions by discharge disposition n (%)
| Survived (n = 19124) | Died (n = 404) | P value | |
| Gastrointestinal flag | 5351 (27.98) | 159 (39.36) | < 0.0001 |
| Cardiovascular flag | 1543 (8.07) | 162 (40.10) | < 0.0001 |
| Hem/immunologic flag | 1662 (8.69) | 152 (37.62) | < 0.0001 |
| Malignancy | 1164 (6.09) | 135 (33.42) | < 0.0001 |
| Metabolic flag | 1138 (5.95) | 135 (33.42) | < 0.0001 |
| Neurologic/neuromusc flag | 2570 (13.44) | 145 (35.89) | < 0.0001 |
| Congenital/genetic flag | 1838 (9.61) | 81 (20.05) | < 0.0001 |
| Renal/urologic flag | 927 (4.85) | 133 (32.92) | < 0.0001 |
| Respiratory flag | 780 (4.08) | 65 (16.09) | < 0.0001 |
| Technology depend. flag | 3710 (19.40) | 242 (59.90) | < 0.0001 |
| Transplant flag | 802 (4.19) | 94 (23.27) | < 0.0001 |
- Citation: Attard TM, Miller M, Pant C, Kumar A, Thomson M. Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study. World J Gastroenterol 2017; 23(9): 1608-1617
- URL: https://www.wjgnet.com/1007-9327/full/v23/i9/1608.htm
- DOI: https://dx.doi.org/10.3748/wjg.v23.i9.1608