We are thankful for the opportunity to respond to the issues raised by Dr Blum's letter and to thank Dr Blum for his interest in our paper
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and taking the time to express his concerns.Dr Blum raises concerns regarding the methodology and conclusions of our study investigating hemoglobin monitoring in acute gastrointestinal bleeding.
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The retrospective design of our study leads to well-known limitations in data interpretation and, more specifically, causality. However, it is important to emphasize that we mitigated these limitations via several approaches. First, the data used in this study were carefully curated, and we specifically used a rigorous definition of gastrointestinal bleeding. Secondly, we employed propensity score matching, which by definition helps match groups.We further emphasize that the primary goal of this study was to bring attention to an area of medical practice that is frequently encountered by many providers, yet we are lacking evidence to guide practice. We do not believe our findings should single-handedly change practice but, rather, should allow for pause and thoughtful consideration when managing acute gastrointestinal bleeding, particularly as resources become increasingly more valuable. Ideally, we hope that this study will act as a launching point for further investigation, particularly a prospective analysis or randomized control trial that would better evaluate the outcomes of today's decision-making when managing acute gastrointestinal bleeding.
Reference
- Hemoglobin monitoring in acute gastrointestinal bleeding: are we monitoring blood counts too frequently?.Am J Med. 2021; 134: 682-687
Article Info
Footnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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