Published online Mar 7, 2017. doi: 10.3748/wjg.v23.i9.1608
Peer-review started: September 10, 2016
First decision: October 28, 2016
Revised: November 11, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: March 7, 2017
To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.
We interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3.
The population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions.
GIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.
Core tip: The management of gastrointestinal haemorrhage in children is challenging insofar as the timing and impact of different interventions remains poorly defined. The authors analysed the characteristics and associated interventions associated with mortality as an outcome with gastrointestinial bleeding in children past infancy. Death associated with gastrointestinal haemorrhage was reported in 2% overall albeit less (0.4%) in the cohort with haemorrhage as admitting diagnosis. Patients who died were far less likely to have undergone endoscopy during the admission and more likely to have received octreotide and less likely to have received proton pump inhibitor therapy during the first two days of admission.