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Upper GI Bleed: Likelihood Ratios

Introduction: None written.

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Tags: Gastrointestinal Problem Tag this Diagnosis.

The likelihood ratios of findings for Upper GI Bleed are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Blood Test
Finding	Result	+LR	-LR
[ + ] Elevated BUN to Creatinine Ratio	+ 0 -	34	0.3
In a PEDIATRIC pt with either an upper or lower GI bleed, when the BUN to Creatinine ratio was 30 or above, the specificity of upper GI bleeding vs. lower GI bleeding was 98% with a sensitivity of 68.8% Study: PMID: 1403455

History
Finding	Result	+LR	-LR
[ + ] History of Ulcer		Sensitivity = 40%
specificity not assessed Study: Gastrointest Endosc. 1995 Nov;42(5):390-7. PMID 8566625
[ + ] Melena	+ 0 -	3.9	0.4
(for specificity, i.e. 18% of lower GI bleed have melena) Study: Emerg Med Clin North Am. 1999 Feb;17(1):239-61, x. PMID 10101349

Imaging
Finding	Result	+LR	-LR
[ + ] Angiography	+ 0 -	inf	0.4
sensitivity 63-90% Study: Radiographics. 2007 Jul-Aug;27(4):1055-70. PMID: 17620467
[ + ] CT angiography	+ 0 -	5.9	0.1
sensitivity reported in animal models to be .3 ml/min Study: World J Gastroenterol. 2010 Aug 21;16(31):3957-63. PMID: 20712058

Untagged
Finding	Result	+LR	-LR
[ + ] Hematochezia		Sensitivity = 14%
i.e. bright red blood in stool specificity not assessed. Study: Emerg Med Clin North Am. 1999 Feb;17(1):239-61, x. PMID 10101349
[ + ] Nasogastric Lavage	+ 0 -	4.7	0.6
in patients without hematemesis Note that in principle if there is no bile, bleeding distal to the pylorus cannot be excluded. Study: Ann Emerg Med. 2004 Apr;43(4):525-32. PMID 15039700
[ + ] Upper Endoscopy	+ 0 -	1.3	0.3
specificity ranges from 30-100% Study: Radiographics. 2007 Jul-Aug;27(4):1055-70. PMID: 17620467