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Predictors of Clinically Significant Upper Gastrointestinal Hemorrhage Among Children With Hematemesis

Freedman, Stephen B.*; Stewart, Charles; Rumantir, Maggie*; Thull-Freedman, Jennifer D.*

Journal of Pediatric Gastroenterology & Nutrition: June 2012 - Volume 54 - Issue 6 - p 737–743
doi: 10.1097/MPG.0b013e3182417a47
Original Articles: Gastroenterology

Objectives: The aim of the study was to determine the proportion of children with hematemesis who experience a clinically significant upper gastrointestinal hemorrhage (UGIH) and to identify variables predicting their occurrence.

Methods: A retrospective cohort study was conducted. All of the emergency department visits by children ages 0 to 18 years who presented with hematemesis between 2000 and 2007 were reviewed. The primary aim of the study was to determine the proportion of children who developed a clinically significant UGIH; the secondary aim was to identify risk factors predictive of a clinically significant UGIH. A significant UGIH was defined by any of the following: hemoglobin drop >20 g/L, blood transfusion, or emergent endoscopy or surgical procedure.

Results: Twenty-seven of 613 eligible children (4%; 95% confidence interval 3%–6%) had a clinically significant UGIH. Clinically significant hemorrhages were associated with older age (9.7 vs 2.9 years; P < 0.001), vomiting moderate to large amounts of fresh blood (58% vs 20%; P < 0.001), melena (37% vs 5%; P < 0.001), significant medical history (63% vs 24%; P < 0.001), unwell appearance (44% vs 6%; P < 0.001), and tachycardia (41% vs 10%; P < 0.001). The frequency of laboratory investigations increased with age (P < 0.001). The hemoglobin level was the only laboratory investigation whose results differed between those with and without significant bleeds. The presence of any one of the following characteristics identified all of the children with a clinically significant hemorrhage: melena, hematochezia, unwell appearance, or a moderate to large volume of fresh blood in the vomitus, sensitivity 100% (95% confidence interval 85%–100%).

Conclusions: The occurrence of a clinically significant UGIH was uncommon among children with hematemesis, especially in well-appearing children without melena, hematochezia, or who had not vomited a moderate to large amount of fresh blood.

*Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada

Division of Pediatric Emergency Medicine, University Hospital of Wales, Cardiff, UK.

Address correspondence and reprint requests to Stephen B. Freedman, MDCM, MSc, FRCPC, Division of Pediatric Emergency Medicine, The Hospital for Sick Children, 555 University Ave, Toronto M5G 1X8, ON, Canada (e-mail:

Received 26 July, 2011

Accepted 7 November, 2011

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN