P. Almela and colleagues studied a cohort of 983 subjects who had all been admitted to the Accident and Emergency Department (A&ED) of the University hospital in Valencia between 1994 and 1997.
All patients were suffering from UGIH not associated with portal hypertension.
Following evaluation in the A&ED, 216 patients (22%) were discharged and referred for outpatient follow-up.
Of these, 15 patients could not be located following discharge from the A&ED, and so were lost to the study, reducing the number of subjects in this group to 201.
In the remaining patients, the main outcomes measured were rebleeding within 10 days, emergency surgery within 15 days, and mortality for any cause during the 30 days following the initial hemorrhaging episode.
The researchers found UGIH in subjects under outpatient care to be less severe than those subjects in the hospitalized group.
Hemorrhage recurred in 7.3% of inpatients compared to 0.5% of outpatients.
Emergency surgery was required in nearly 6% of the hospitalized patients but in less than 1% of the outpatients.
A total of 20 deaths were recorded in the hospitalized group (2.6%), while only 3 (1.5%) occurred in outpatients.
After adjusting for several significant risk factors, the research group found that outpatient management was not associated with outcomes that were worse than those identified in the inpatient group.
| Outpatients fared no worse than inpatients |
| the American Journal of Gastroenterology|
They therefore conclude that treatment under an outpatient regimen is a safe alternative for a large percentage of selected patients with UGIH not associated with portal hypertension.