Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study

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

IQR: Interquartile ranges; GER: Gastroesophageal reflux; PPI: Proton pump inhibitor; H₂RA: H₂-receptor antagonists; CT: Computed tomography; MRI: Magnetic resonance imaging; GIB: Gastrointestinal bleeding; EGD: Esophagogastroduodenoscopy.

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

IQR: Interquartile ranges; GER: Gastroesophageal reflux; PPI: Proton pump inhibitors; H₂RA: H₂-receptor antagonists; CT: Computed tomography; MRI: Magnetic resonance imaging; GIB: Gastrointestinal bleeding; EGD: Esophagogastroduodenoscopy.

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)

GI: Gastrointestinal; ICD-9: International Classification of Diseases, Ninth Revision.

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

GI: Gastrointestinal.

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