Retrospective Cohort Study
Copyright ©The Author(s) 2021.
World J Clin Cases. Apr 16, 2021; 9(11): 2446-2457
Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2446
Table 1 Baseline patient characteristics
Total
Urgent CT
Elective CT
P value
n = 182
n = 100
n = 82
Number of men, n (%)126 (69.2)71 (71.0)55 (67.1)0.65
Median age, yr, mean ± SD71 ± 12.469 ± 13.372 ± 11.00.34
BMI, kg/m2, mean ± SD23.5 ± 3.523.8 ± 3.523.1 ± 3.50.15
Pulse rate, beat/min, mean ± SD81.3 ± 15.980.9 ± 15.981.8 ± 15.80.77
Systolic blood pressure, mmHg, mean ± SD133.2 ± 24.8132.8 ± 24.7133.1 ± 25.10.74
Hypertension, %58.655.959.00.72
Diabetes mellitus, %15.518.613.30.44
Cerebrovascular disease, %17.719.614.50.38
Ischemic heart disease, %18.814.724.70.15
History of CDB, %36.541.228.90.10
Bowel preparation1, %57.151.064.60.09
Low-dose aspirin (≤ 100 mg/d), %20.419.620.50.99
Non-aspirin antiplatelets, %16.013.718.10.54
Anticoagulants, %9.48.89.60.99
NSAIDs, %16.619.6120.24
Syncope, %8.811.86.00.27
Abdominal pain, %3.94.92.40.62
Hemoglobin, g/dL, mean ± SD11.4 ± 2.411.5 ± 2.411.3 ± 2.40.38
Platelet, count/mm3, mean ± SD20.3 ± 5.520.4 ± 5.819.9 ± 5.30.54
Cr, mg/dL, mean ± SD1.1 ± 1.11.2 ± 1.31.0 ± 0.70.24
1Bowel preparation was defined as colonic irrigation with polyethylene glycol. BMI: Body mass index; CDB: Colonic diverticular bleeding; CT: Computed tomography; CKD: Chronic kidney disease; NSAIDs: Non-steroidal inflammatory drugs; Cr: Creatinine.
Table 2 Outcomes by timing of computed tomography imaging
Total
Urgent CT
Elective CT
P value
n = 182
n = 100
n = 82
Extravasation-positive rate, n (%)67 (36.8)47 (47.0)20 (24.4)< 0.01
SRH identification, n (%)41 (22.5)35 (35.0)6 (7.3)< 0.01
Active bleeding30 (16.5)26 (26.0)4 (4.9)< 0.01
Adherent clot7 (3.8)6 (6.0)1 (1.2)0.06
Non-bleeding visible vessel4 (2.2)3 (3.0)1 (1.2)0.32
Hospitalization length of stay, d, mean ± SD7.4 ± 5.37.1 ± 4.17.7 ± 6.30.40
Need for interventional radiology, n (%)4 (2.2)1 (1.0)3 (3.7)0.48
Need for surgery, n (%)4 (2.2)0 (0.0)4 (4.9)0.08
Blood transfusion, n (%)40 (22.0)24 (24.0)16 (19.5)0.61
Amount of transfusion, units, mean ± SD1.1 ± 2.71.2 ± 2.61.0 ± 2.80.46
Blood transfusion after SRH, n (%)17 (9.3)13 (13.0)4 (4.9)0.11
Contrast media-related adverse events
Nausea, vomiting n (%)1 (0.6)1 (1.0)0
Urticaria and skin rash, n (%)000
Pruritus, n (%)1 (0.6)01 (1.2)
Erythema, n (%)000
Laryngeal edema, n (%)000
Sneezing, n (%)000
Coughing, n (%)000
Contrast media-related severe adverse events
Dyspnea, n (%)000
Sudden drop in blood pressure, n (%)000
Loss of consciousness, n (%)000
Cardiac arrest, n (%)000
CT: Computed tomography; RCC: Red cell concentrate; SRH: Stigmata of recent hemorrhage.
Table 3 Rate of stigmata of recent hemorrhage identification by the division of a short time (12 h) from last hematochezia to colonoscopy
Rate of SRH identification by contrast-enhanced CT findings (%)
Extravasation-positive cases
Extravasation-negative cases
Time from last hematochezia to colonoscopy within 12 h
Time from last hematochezia to colonoscopy after 12 h
P value
Time from last hematochezia to colonoscopy within 12 h
Time from last hematochezia to colonoscopy after 12 h
P value
Urgent CT group (≤ 4 h)61.8 (21/34)76.9 (10/13)0.528.7 (2/23)6.7 (2/30)1.00
Elective CT group (> 4 h)18.2 (2/11)22.2 (2/9)NA4.5 (1/24)2.6 (1/38)1.00
P value0.03NA0.970.83
SRH: Stigmata of recent hemorrhage; CT: Computed tomography; NA: Not available.
Table 4 Rate of stigmata of recent hemorrhage identification within 24 h from last hematochezia to colonoscopy
Rate of SRH identification by contrast-enhanced CT findings (%)
Extravasation-positive cases
Extravasation-negative cases
Time from last hematochezia to colonoscopy within 24 h
Time from last hematochezia to colonoscopy within 24 h
P value
Urgent CT group (≤ 4 h)66.0 (31/47)7.5 (4/53)< 0.01
Elective CT group (> 4 h)20.0 (4/20)3.2 (2/62)0.31
P value< 0.010.54
SRH: Stigmata of recent hemorrhage; CT: Computed tomography.
Table 5 Rate of rebleeding by the division of a short time (12 h) from last hematochezia to colonoscopy
Rate of rebleeding within 30 d by contrast-enhanced CT findings (%)
Extravasation-positive cases
Extravasation-negative cases
Time from last hematochezia to colonoscopy within 12 h
Time from last hematochezia to colonoscopy after 12 h
P value
Time from last hematochezia to colonoscopy within 12 h
Time from last hematochezia to colonoscopy after 12 h
P value
Urgent CT group (≤ 4 h)5.9 (2/34)7.7 (1/13)1.0030.4 (7/23)33.3 (10/30)1.00
Elective CT group (> 4 h)36.4 (4/11)22.2 (2/9)NA16.7 (4/24)21.1 (8/38)0.92
P value0.04NA0.440.39
CT: Computed tomography; NA: Not available.
Table 6 Rate of rebleeding within 24 h from last hematochezia to colonoscopy
Rate of rebleeding within 30 d by contrast-enhanced CT findings (%)
Extravasation-positive cases
Extravasation-negative cases
Time from last hematochezia to colonoscopy within 24 h
Time from last hematochezia to colonoscopy within 24 h
P value
Urgent CT group (≤ 4 h)6.4 (3/47)32.1 (17/53)< 0.01
Elective CT group (> 4 h)30.0 (6/20)19.4 (12/62)0.49
P value0.030.18
CT: Computed tomography.
Table 7 Stigmata of recent hemorrhage identification in extravasation-positive cases by contrast-enhanced computed tomography
SRH identification rate (%)
Extravasation-positive cases
Extravasation-negative cases
All SRH
Active bleeding of SRH
Adherent clot of SRH
NBVV of SRH
All CDB52.2 (35/67)35.8 (24/67)10.4 (7/67)6.0 (4/67)5.2 (6/115)
Urgent CT group (≤ 4 h)66.0 (31/47)46.8 (22/47)12.8 (6/47)4.5 (3/47)7.5 (4/53)
Elective CT group (> 4 h)20.0 (4/20)10.0 (2/20)5.0 (1/20)5.0 (1/20)3.2 (2/62)
P value< 0.01< 0.010.450.830.54
Concordance rate of extravasation-positive site to SRH identification site (%)
All SRHActive bleeding of SRHAdherent clot of SRHNBVV of SRH
All CDB91.4 (32/35)91.7 (22/24)85.7 (6/7)100 (4/4)
Urgent CT group (≤ 4 h)90.3 (28/31)90.9 (20/22)83.3 (5/6)100 (3/3)
Elective CT group (> 4 h)100 (4/4)100 (2/2)100 (1/1)100 (1/1)
Values in parentheses are numerator/denominator. CT: Computed tomography; CDB: Colonic diverticular bleeding; SRH: Stigmata of recent hemorrhage; NBVV: Non-bleeding visible vessels.
Table 8 Accuracy of contrast-enhanced computed tomography findings for predicting stigmata of recent hemorrhage identification by colonoscopy
Sensitivity
Specificity
Positive likelihood ratio
Negative likelihood ratio
All CDB85.4 (70.8-94.4)77.3 (69.5-83.9)3.69 (2.66-5.13)0.20 (0.10-0.41)
Urgent CT group ≤ 4 h88.6 (73.3-96.8)75.4 (63.1-85.2)3.50 (2.26-5.41)0.17 (0.07-0.40)
Elective CT group > 4 h66.7 (22.3-95.7)78.9 (68.1-87.5)3.00 (1.49-6.03)0.46 (0.17-1.24)
Values in parentheses are 95% confidential intervals. Likelihood ratios were estimated by using the substitution formula. CT: Computed tomography; CDB: Colonic diverticular bleeding.
Table 9 Relationship between detection of stigmata of recent hemorrhage and contrast-enhanced computed tomography examination
All cases
Urgent CT group (≤ 4 h)
Elective CT group (> 4 h)
Extravasation-positiveExtravasation-negativeExtravasation-positiveExtravasation-negativeExtravasation-positiveExtravasation-negative
SRH-positive35631442
SRH-negative3210916491660
SRH identification rate (%)52.2 (35/67)5.2 (6/115)66.0 (31/47)7.5 (4/53)20.0 (4/20)3.2 (2/62)
P value< 0.01
P value: Urgent CT group (extravasation-positive) vs Elective CT group (extravasation-positive). SRH: Stigmata of recent hemorrhage; CT: Computed tomography.