Background: Upper Gastrointestinal Bleeding (UGIB) is a common Emergency Department (ED)presentation with high morbidity and mortality. There is a paucity of data on the profile and outcome of patients who present with UGIB to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania.
Methodology: This was a prospective cohort study of consecutive adult (≥18 years) patients presenting to the EDs of Muhimbili National Hospital (EMD-MNH) and MUHAS Academic Medical Centre (EMD-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. We used the clinical Rockall score to assess disease severity. The primary outcome of 7- day mortality was summarized using descriptive statistics. Regression analysis was performed to identify predictors of mortality.
Results: During the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42 years (IQR 32-64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7 days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24 hours. There were no ED deaths. About 65.1% of the patients had severe anemia but only 60 (48.8%) received blood transfusion in the ED. Amongst those with h/o esophageal varices 7(41.2%) did not receive octreotide. Only 8 (17.4%) received endoscopy within 24 hours, all of who had a low or moderate clinical Rockall score i.e. <3 and 3-4. Age >40 years was a significant independent predictor of mortality (OR=7.00 (95% CI 1.9-26.4). Receiving UGI endoscopy was independently associated with a lower risk of mortality (OR= 0.27; 95% CI 0.08-0.9.)
Conclusion & Recommendations: In this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age < 40 years and endoscopic evaluation during the hospital stay were independent predictors of lower mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy so as to improve outcomes