Prediction of hospitalization and blood transfusion requirement in patients with macroscopic hematuria

Year 2021, , 315 - 318, 24.09.2021

Hasan Basri Çetinkaya , Harun Güneş

https://doi.org/10.38053/acmj.978838

Abstract

Aim: It was aimed to find out simple parameters that can be used in the emergency triage and can discriminate patients requiring hospitalization or blood transfusion (BT) among those presenting with macroscopic hematuria (MH).
Material and Method: Medical records of the patients presenting to the emergency department (ED) with MH were investigated retrospectively. The patients’ vital signs including pulse rate (PR), systolic blood pressure (SBP) and diastolic blood pressure, and laboratory test results including hemoglobin, platelet count and international normalized ratio were recorded. Shock index (SI) was calculated using SBP and PR of each patient.
Results: Seventy seven patients were recruited into the study. PR and SI were found to significantly differ between the patients discharged from the ED and those who needed hospitalization. Hospitalized patients were seen to have higher PR values and SI compared to discharged ones. PR and SI were higher in patients requiring BT compared to those who did not require transfusion.
Conclusion: Use of PR and SI in the emergency triage may be helpful while discriminating patients who need hospitalization or BT among those presenting with MH.

Keywords

Macroscopic hematuria, hospitalization, blood transfusion, shock index, pulse rate

References

• Amling CL. Diagnosis and management of superficial bladder cancer. Curr Probl Cancer 2001; 25: 219–78.
• Smet CE, De Hurtado JM, Pareja RR, et al. Analysis of 895 consultations for hematuria in the emergency department in an urology unit. J Urol (Paris) 1996; 102: 168–71.
• Mommsen S, Aagaard J, Sell A. Presenting symptoms, treatment delay and survival in bladder cancer. Scand J UrolNephrol 1983; 17: 163–7.
• Goonewardena SA, AbeygunasekeraAM. Haematuria as the presenting symptom: experience from a tertiary referral centre in Sri Lanka. Ceylon Med J 1998; 43: 156–8.
• Rodgers M, Nixon J, Hempel S, et al. Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation. Health Technol Assess 2006; 18: 259.
• Paul AB, Collie DA, Wild SR, Chisholm GD. An integrated haematuria clinic. Br J ClinPract 1993; 47: 128–30.
• Wallace DM, Bryan RT, Dunn JA, et al. Delay and survival in bladder cancer. BJU Int 2002; 89: 868–78.
• Thiruchelvam N, Mostafid H. Do patients with frank haematuria referred under the two-week rule have a higher incidence of bladder cancer? Ann R CollSurg Engl 2005; 87: 345–7.
• Hicks D, Li CY. Management of macroscopic haematuria in the emergency department. Emerg Med J 2007; 24: 385-90.
• Sankaran P, Kamath AV, Tariq SM, et al. Are shock index and adjusted shock index useful in predicting mortality and length of stay in community-acquired pneumonia? Eur J Intern Med 2011; 22: 282-5.
• Semerci E, Durukan P, Yıldırım S, Baykan N, Yakar Ş, İpekten F. The effect of shock index and hematocrit levels on mortality in patients with gastrointestinal bleeding. Turk J Acad Gastroenterol 2018; 17: 85-9.
• Mutschler M, Nienaber U, Münzberg M, et al. The shock index revisited - a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the Trauma Register DGU®. Crit Care 2013; 17: R172.
• Rassameehiran S, Teerakanok J, Suchartlikitwong S, Nugent K. Utility of the shock index for risk stratification in patients with acute upper gastrointestinal bleeding. South Med J 2017; 110: 738-43.
• Otero R, Nguyen B. Şoktaki hastaya yaklaşım. In: Yıldıray Ç., editor. Acil Tıp KapsamlıBirÇalışmaKlavuzu. 7th edition.İstanbul: Nobel Tıp Kitabevi; 2013. p. 165-172
• Choong SK, Walkden M, Kirby R. The management of intractable haematuria.BJU Int 2000; 86: 951–9.
• Goonewardena SA, Abeygunasekera AM. Haematuria as the presenting symptom: experience from a tertiary referral centre in Sri Lanka. Ceylon Med J 1998; 43: 156-8.
• Rockall AG, Newman-Sanders AP, al-Kutoubi MA, et al. Haematuria. Postgrad Med J 1997; 73: 129-36
• Culclasure TF, Bray VJ, Hasbargen JA. The significance of hematuria in the anticoagulated patient. Arch Intern Med 1994; 154: 649-52.
• Al Jalbout N, Balhara KS, Hamade B, Hsieh YH, Kelen GD, Bayram JD. Shock index as a predictor of hospital admission and inpatient mortality in a US national database of emergency departments. Emerg Med J 2019; 36: 293-7.
• Kocaoğlu S, Çetinkaya HB. Use of age shock index in determining severity of illness in patients presenting to the emergency department with gastrointestinal bleeding. Am J Emerg Med 2021; 47: 274-8.
• Saffouri E, Blackwell C, Laursen SB, et al. The shock index is not accurate at predicting outcomes in patients with upper gastrointestinal bleeding. Aliment PharmacolTher 2020; 51: 253–60.
• El-Menyar A, Goyal P, Tilley E, Latifi R. The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma. J Surg Res 2018; 227: 52-9.
• Terceros-Almanza LJ, García-Fuentes C, Bermejo-Aznárez S, et al. Prediction of massive bleeding. shock index and modified shock index. Med Intensiva 2017; 41: 532-8.