Emergency Department Utilization and Disposition Outcomes for Gastrointestinal Bleeding: A Nationwide Analysis

Gastrointestinal (GI) bleeding is a common cause of emergency department (ED) visits and is associated with substantial morbidity and healthcare utilization. We aimed to evaluate nationwide trends in incidence, demographic characteristics, and resource utilization among patients presenting to the ED with GI bleeding.

We conducted a retrospective analysis of the National Emergency Department Sample from 2016-2022, identifying weighted ED visits for GI bleeding among adults aged ≥18 years. The primary outcome was temporal trends in ED visit volume for gastrointestinal bleeding. Secondary outcomes included trends in resource utilization, healthcare charges, comorbidity prevalence, disposition, and in-hospital mortality. Patient demographics, comorbidities, CPT-coded procedures, payer status, hospital characteristics, disposition, mortality, and ED and inpatient charges were analyzed.

A total of 2,662,863 weighted ED visits for GI bleeding were identified over the study period. The annual number of ED visits for GI bleeding declined steadily from 428,800 in 2016 to 337,157 in 2022, representing a 21% relative decrease over the study period . The mean age was 66 (±17), and 52% were male. Mean weighted ED charges demonstrated a significant upward temporal trend, increasing from $4,728 in 2016 to $9,440 in 2022, representing an approximate twofold increase over the study period. Comorbidity analysis revealed hypertension was the most prevalent comorbidity (59%), followed by hyperlipidemia (31%). The prevalence of obesity increased over the study period, rising from 8.9% in 2016 to 10.9% in 2022. Overall mortality increased from 5.9% in 2016 to 8.1% in 2022. Inpatient mortality rose from 5.3% to 7.1% during the study period, accounting for the majority of deaths, while ED mortality increased from 0.6% to 0.9%. Across all study years, 693,789 (26.1%) of patients were discharged home from the emergency department, while the majority required inpatient admission 1,541,314 (57.9%). In survey-weighted logistic regression, there was no clinically meaningful change in the likelihood of hospital admission over time (OR per year, 0.99; 95% CI, 0.98–1.00).

Despite fewer ED visits for GI bleeding, rising metabolic comorbidities and hospital charges reflect a growing healthcare burden and the need for improved outpatient prevention and risk stratification.