EBQ:Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis: Difference between revisions
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==Major Points== | ==Major Points== | ||
Test characteristics of nasogastric aspiration for upper GI bleed source: | |||
* Sensitivity | * Sensitivity: 42%-84% | ||
* Specificity | * Specificity: 54%-91% | ||
==Study Design== | ==Study Design== | ||
Revision as of 16:43, 6 October 2014
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Clinical Question
Is nasogastric lavage and aspiration in the ED an effective test to distinguish between an upper versus lower source of GI bleed in patients who have either melena or hematochezia without hematemesis?
Conclusion
The diagnostic performance of nasogastric aspiration in identifying upper GI source of bleed is poor.
Major Points
Test characteristics of nasogastric aspiration for upper GI bleed source:
- Sensitivity: 42%-84%
- Specificity: 54%-91%
Study Design
Systematic literature review. The authors identified 969 studies related to their question, 3 of which met inclusion criteria for the review.
Population
Patient Demographics
Varied, depending on the study.
- Mean age: 66-73
- Gender: 62-66% male
Inclusion Criteria
Cross sectional studies in which all patients presenting with melena or hematochezia underwent nasogastric aspiration (with or without lavage) followed by esophagogastroduodenal endoscopy (EGD).
Exclusion Criteria
Studies that included patients with esophageal varices, hematemesis, or coffee ground emesis.
Interventions
As this is a review article, the authors performed no interventions. In each study, all patients underwent nasogastric aspiration and EGD.
Outcomes
Primary Outcome
Accuracy of nasogastric aspiration in identifying an upper source of GI bleed.
Secondary Outcomes
Complications from nasogastric tube insertion.
Subgroup analysis
None.
Criticisms & Further Discussion
- All three papers reviewed are retrospective cross-sectional studies, only one of which blinded data abstractors to outcomes.
- All studies used a different reference or 'gold' standard (active bleeding on EGD vs. stigmata of recent bleeding, etc.)