EBQ:Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis
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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
Major Points
Study Design
Systematic literature review.
Population
Patient Demographics
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
Outcomes
Primary Outcome
Accuracy of nasogastric aspiration in identifying an upper source of gastrointestinal bleed.
Secondary Outcomes
Complications from nasogastric tube insertion.
Subgroup analysis
Criticisms & Further Discussion
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All three studies reviewed are retrospective cross-sectional studies, only one of which blinded data abstractors to outcomes.
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All studies used a different reference (or 'gold') standard: active bleeding versus stigmata or recent bleeding or