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Eur J Gastroenterol Hepatol. 2004 May;16(5):487-94.

Effectiveness of an upper-gastrointestinal haemorrhage unit: a prospective analysis of 900 consecutive cases using the Rockall score as a method of risk standardisation.

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  • 1Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK. d.s.sanders28@btopenworld.com

Abstract

OBJECTIVES:

To assess the effectiveness of a centralised upper-gastrointestinal haemorrhage (UGIH) unit.

METHODS:

The UK Audit of acute UGIH resulted in the formulation of a simple numerical scoring system. The Rockall score categorises patients by risk factors for death and allows case-mix comparisons. A total of 900 consecutive patients admitted to a UGIH unit between October 1995 and July 1998 were analysed prospectively. Patients were given an initial Rockall score and, if endoscopy was performed, a complete score. This method of risk stratification allowed the proportion of deaths (in our study) to be compared with the National Audit using risk standardised mortality ratios.

RESULTS:

The distribution of both initial and final Rockall scores was significantly higher in our study than in the National Audit. A total of 73 (8.1%) patients died, compared with the National Audit mortality of 14%. Risk-standardised mortality ratios using both initial and complete Rockall scores were significantly lower in our study when compared with those in the National Audit.

CONCLUSION:

A specialised UGIH unit is associated with a lower proportion of deaths from UGIH, despite comprising a greater number of high-risk patients than the National Audit. This lower mortality therefore cannot be attributed to a more favourable case mix and demonstrates that further improvements in mortality for UGIH can be made.

PMID:
15097042
[PubMed - indexed for MEDLINE]
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