{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:54:54Z","timestamp":1760028894327},"reference-count":12,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,10,4]],"date-time":"2017-10-04T00:00:00Z","timestamp":1507075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Assessing the likelihood of a variceal versus nonvariceal source of upper gastrointestinal bleeding (<jats:styled-content style=\"fixed-case\">UGIB<\/jats:styled-content>) guides therapy, but can be difficult to determine on clinical grounds. The objective of this study was to determine if there are easily ascertainable clinical and laboratory findings that can identify a patient as low risk for a variceal source of hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study of adult <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> patients with <jats:styled-content style=\"fixed-case\">UGIB<\/jats:styled-content> between January 2008 and December 2014 who had upper endoscopy performed during hospitalization. Clinical and laboratory data were abstracted from the medical record. The source of the <jats:styled-content style=\"fixed-case\">UGIB<\/jats:styled-content> was defined as variceal or nonvariceal based on endoscopic reports. Binary recursive partitioning was utilized to create a clinical decision rule. The rule was internally validated and test characteristics were calculated with 1,000 bootstrap replications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 719 patients were identified; mean age was 55 years and 61% were male. There were 71 (10%) patients with a variceal <jats:styled-content style=\"fixed-case\">UGIB<\/jats:styled-content> identified on endoscopy. Binary recursive partitioning yielded a two\u2010step decision rule (platelet count &gt; 200 \u00d7 10<jats:sup>9<\/jats:sup>\/L and an international normalized ratio [<jats:styled-content style=\"fixed-case\">INR<\/jats:styled-content>] &lt; 1.3), which identified patients who were low risk for a variceal source of hemorrhage. For the bootstrapped samples, the rule performed with 97% sensitivity (95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] = 91%\u2013100%) and 49% specificity (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 44%\u201353%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although this derivation study must be externally validated before widespread use, patients presenting to the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> with an acute <jats:styled-content style=\"fixed-case\">UGIB<\/jats:styled-content> with platelet count of &gt;200 \u00d7 10<jats:sup>9<\/jats:sup>\/L and an <jats:styled-content style=\"fixed-case\">INR<\/jats:styled-content> of &lt;1.3 may be at very low risk for a variceal source of their upper gastrointestinal hemorrhage.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13297","type":"journal-article","created":{"date-parts":[[2017,8,22]],"date-time":"2017-08-22T11:34:35Z","timestamp":1503401675000},"page":"1405-1409","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Identifying Emergency Department Patients at Low Risk for a Variceal Source of Upper Gastrointestinal Hemorrhage"],"prefix":"10.1111","volume":"24","author":[{"given":"Lauren R.","family":"Klein","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Money","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaveesh","family":"Maharaj","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarissa","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian E.","family":"Driver","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,10,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0901512"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2012.05088.x"},{"issue":"9","key":"e_1_2_7_4_1","first-page":"CD002907","article-title":"Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding","author":"Chavez\u2010Tapia NC","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_5_1","first-page":"187","article-title":"Predictors of a variceal source among patients presenting with upper gastrointestinal bleeding","volume":"26","author":"Alharbi A","year":"2012","journal-title":"Can J Gastroenterol Hepatol"},{"key":"e_1_2_7_6_1","first-page":"379","article-title":"Predictors of variceal or nonvariceal source of upper gastrointestinal bleeding. An etiology predictive score established and validated in a tertiary referral center","volume":"22","author":"Matei D","year":"2013","journal-title":"J Gastrointest Liver Dis"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.15.1099"},{"key":"e_1_2_7_8_1","first-page":"172","article-title":"Nasogastric aspirate predicts high\u2010risk endoscopic lesions in patients with acute upper\u2010GI bleeding","volume":"59","author":"Aljebreen AM","year":"2004","journal-title":"Gastroendoscopy"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.52.8.1200"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.4103\/1319-3767.58767"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(99)70309-4"},{"key":"e_1_2_7_12_1","volume-title":"An introduction to recursive partitioning using the RPART routines","author":"Atkinson EJ","year":"2000"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1011170"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Facem.13297","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.13297","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T15:47:43Z","timestamp":1695743263000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.13297"}},"subtitle":[],"editor":[{"given":"Robert T.","family":"Gerhardt","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2017,10,4]]},"references-count":12,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1111\/acem.13297"],"URL":"https:\/\/doi.org\/10.1111\/acem.13297","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,4]]},"assertion":[{"value":"2017-02-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-08-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-10-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}