Selective Outpatient Management of Upper Gastrointestinal Bleeding in the Elderly: Results from the SOME Bleeding Study.
To determine whether elderly patients with upper gastrointestinal bleeding could be safely managed as outpatients, 84 patients (65 years and older) were studied over a 23-month period. Urgent outpatient endoscopy was performed and clinical as well as endoscopic criteria were applied to determine the need for hospital admission. Patients with endoscopic findings that indicated a low risk for rebleeding were not admitted if they lacked one major or three minor predefined clinical criteria. All enrollees were monitored with hematocrit determination and clinical assessments for 4 weeks after discharge from the clinic or hospital. Twenty-four (29%) patients were treated as outpatients; none rebled. In contrast, seven (12%) of the 60 inpatients had one or more rebleeding episodes (p = 0.002). Bleeding from peptic ulcer disease was associated with use of nonsteroidal anti-inflammatory medications in 81% of patients. We conclude that selective outpatient management of elderly patients with upper gastrointestinal bleeding can be done safely and can potentially reduce health care expenditures.