Beiermeister, K

Park, John S, MD

Sinnott, Robert J

Smith, L

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryThe Value of Bleeding Scans in the Evaluation ofAcute Lower Gastrointestinal BleedingK BeiermeisterLehigh Valley Health NetworkL SmithLehigh Valley Health NetworkRobert J. SinnottLehigh Valley Health Network, Robert_J.Sinnott@lvhn.orgJohn S. Park MDLehigh Valley Health Network, John_S.Park@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/surgeryPart of the Other Medical Specialties Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtBeiermeister, k., Smith, L., Sinnott, R., & Park, J. (2013, March). The value of bleeding scans in the evaluation of acute lower gastrointestinalbleeding. Poster presented at: The Pennsylvania Society of Colon and Rectal Surgeons, Philadelphia, PA.Lehigh Valley Health Network, Allentown, PennsylvaniaThe Value of Bleeding Scans in the Evaluation of Acute Lower Gastrointestinal BleedingBeiermeister, K., Smith, L., Sinnott, R., Park, J.References:1.	 	Gutierrez	et	al.	The	Use	of	Technetium-Labeled	Erythrocyte	Scintigraphy	in	the	Evaluation	and	Treatment	of	Lower	Gastrointestinal	Hemorrhage.	Am	Surg,	1998;10(64)	989-992.2.	 	Hammond	et	al.	Implications	of	Negative	Technitium	99m-Labeled	Red	Blood	Cell	Scintigraphy	in	Patients	Presenting	with	Lower	Gastrointestinal	Bleeding.	Am	J	Surg,	2007;193	404-408.3.	 	Olds	et	al.	The	Yield	of	Bleeding	Scans	in	Acute	Lower	Gastrointestinal	Hemorrhage.	J	Clin	Gastroenterol,	2005;	39(4)	273-277.4.	 	Suzman	et	al.	Accurate	Localization	and	Surgical	Management	of	Active	Lower	Gastrointestinal	Hemorrhage	with	Technetium-Labeled	Erythrocyte	Scintigraphy.	Ann	Surg;	1996,	224(1)	29-36.	BackgroundMethodsA retrospective chart review was performed on all patients admitted for lower GI bleeding between 2007 and 2010 at a large tertiary center.  We first identified those patients for whom a bleeding scan was included in the diagnostic workup.   Further analysis determined whether these scans were positive or negative and what, if any, interventions were performed.  In addition to defined interventions, the charts were also reviewed for units of PRBCs transfused prior to scan, and presence or absence of anticoagulation.ConclusionAcute lower gastrointestinal (GI) bleeding has been reported to occur in 20 to 27 cases per 100,000 adults and accounts for one fifth to one third of all hospital admissions for GI bleeding. Bleeding scans have become a common tool in the diagnostic evaluation of these patients.  The purpose of this study is to evaluate the role of bleeding scan in the patient with acute lower GI bleed, and to identify those patients more likely to have a positive test.Results137 patients were identified during the study period.  Fifty-one scans were positive (37.2%) and 86 (62.8%) were negative. Patients with a positive bleeding scan were found to have a higher total pre-scan average transfusion requirement (6.32 vs 3.33, P<0.001), as well as a higher transfusion requirement in the 24 hour period preceding the scan (3.65 vs 2.26, P=0.021). Patients on anticoagulant therapy were more likely to have a positive scan (72.5% vs 51.2%, P=0.023).  Twenty-nine (56.8%) patients underwent further intervention based on a positive bleeding scan.  The rate of operative intervention was 9.5%, which is consistent with previously published data regarding lower GI bleeding.   Positive bleeding scans are associated with a higher pre-procedure transfusion requirement as well as use of anticoagulant medication.  These results bring into question the exact role of bleeding scans as they apply to the algorithm associated with the work up of acute lower GI bleeding.  With stricter transfusion requirements applied to the ordering of this study, it stands to reason that the predictive value of a study that currently has a sensitivity of approximately fifty percent will be improved.© 2013 Lehigh Valley Health Network137 pts underwentbleeding scan51 positive 86 negativeAvg pre-scantransfusionrequirementof 6.32 unitsAvg pre-scantransfusionrequirementof 3.33 units29 with someintervention:Angio/OR (rateof operativeintervention9.5%)22 with nointervention

The Value of Bleeding Scans in the Evaluation of Acute Lower Gastrointestinal Bleeding

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The Value of Bleeding Scans in the Evaluation of Acute Lower Gastrointestinal Bleeding

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