Strate et al reported risk factors that can help identify a patient with lower intestinal hemorrhage who is likely to have a severe bleed. The findings can be often be detected on initial evaluation and can help identify those patients who may benefit from closer monitoring and more aggressive management. The authors are from Brigham and Women's Hospital, Dana Farber Cancer Institute and Harvard Medical School.
Independent risk factors:
(1) heart rate >= 100 beats per minute on initial examination
(2) systolic blood pressure <= 115 mm Hg
(3) syncope
(4) nontender abdominal examination on initial examination
(5) bleeding per rectum during the first 4 hours of evaluation
(6) daily aspirin use (at any dose)
(7) Charlson comorbidity index score > 2
Risk Factor
Odds Ratio
95% CI
p value
heart rate
3.67
1.78 - 7.57
< 0.001
systolic blood pressure
3.45
1.54 - 7.72
0.003
syncope
2.82
1.06 - 7.46
0.04
nontender abdominal exam
2.43
1.22 - 4.85
0.01
bleeding during first 4 hours
2.32
1.28 - 4.20
0.005
daily aspirin use
2.07
1.12 - 3.82
0.02
Charlson comorbidity index
1.93
1.08 - 3.44
0.02
from Table 3, page 842
where:
• Several of these findings are those of significant acute hemorrhage (tachycardia, minimal hypotension, syncope).
• The Charlson comorbidity index score is described in Chapter 1.
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