Retrospective investigation of the effectiveness of fecal occult blood test (FOB), PT-APTT in patients admitted to emergency department with gastrointestinal bleeding

The purpose of our study is to investigate the fact that gastrointestinal system bleeding, which is a major cause of mortality, is not diagnosed faster by any additional laboratory tests except physical examination and endoscopy, but it is negative in terms of time, workload and cost. Our study was retrospective and the hospital information system was scanned and the patients who were referred to Emergency Medicine Clinic between 01.08.2012-08.08.2013 with Gastrointestinal System (GIS) bleeding symptoms and then underwent endoscopic examination were investigated. Demographic characteristics, physical examination findings, vital signs, required examinations, digital rectal examination findings, endoscopy and colonoscopy results were recorded in the study form. For statistical analysis, SPSS (Statistical Package for Social Sciences) 17.0 program was used. A total of 274 patients aged 18 years and over were admitted to the study and 61.7% were male and 38.3% were female. Most of the patients in our diagnostic group were in the 70-79 age group. Sensitivity of Digital Rectal Examination (DRE) value was 79.6% Specificity 92.30%, negative predictive value (NPV) 60%, Sensitivity of Fecal Occult Blood Test (FOB) value was 31.46% NPV 30.49%, sensitivity of international normalized ratio (INR) was 26.25% NPV 32,95%, sensitivity of prothrombin time (PT) was 19.37%, NPV 34.84%, sensitivity of activated partial thromboplastin time (aPTT) was 14.19% NPV 34.43%. Endoscopies were performed in 169 patients with GIS bleeding and no active bleeding detected in 56 (33.1%) patients and in 113 (66.9%) patients active bleeding was detected. In patients with positive digital rectal examination findings, endoscopy results were also highly positive for gastrointestinal system bleeding. Our study suggests that; Running FOB, PT, APTT, INR tests in patients admitted to emergency department with GIS bleeding, is far from giving important and necessary information about the emergency management of the patients to emergency medicine specialists. The results of the digital rectal examination correlate with endoscopy results. It is also an easy and time-consuming examination method. From this point of view, we would like to emphasize that making the DRE of all patients with suspected GIS bleeding is a correct and immediate approach to the emergency physician

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Lo BM. Lower Gastrointestinal Bleeding. In: Tinnitalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, eds, Tinnitalli’s Emergency Medicine, 8th edition. MC Graw- Hill, New York, 2016;506-8.

Ziebell CM, Kitlowsky A, Welch JM, Friesen PA. Upper Gastrointestinal Bleeding. In: Tinnitalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, eds, Tinnitalli’s Emergency Medicine, 8th edition. MC Graw- Hill, New York, 2016;503-6.

Osman D, Djibré M, Silva DD, Goulenok C. Management by the intensivist of gastrointestinal bleeding in adults and children. Ann Intensive Care. 2012;2(1):46.

Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, Sinclair P. International Consensus Upper Gastrointestinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101-13.

Colle I, Wilmer A, Le Moine O, Debruyne R, Delwaide J, Dhondt E, Macken E, Penaloza A, Piessevaux H, Stephenne X, Van Biervliet S, Laterre PF. Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children. Acta Gastroenterol Belg. 2011;74(1):45-66.

Palamidessi N, Sinert R, Falzon L, Zehtabchi S. Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemezis. Acad Emerg Med. 2010;17(2):126-32.

Chiang TH, Lee YC, Tu CH, Chiu HM, Wu MS. Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract. CMAJ. 2011;183(13):1474-81.

Chiang CH, Jeng JE, Wang WM, Jheng BH, Hsu WT, Che BH. A comparative study of three fecal occult blood tests in upper gastrointestinal bleeding. Kaohsiung J Med Sci. 2006;22(5):223-8.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )
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