Risk assessment in upper gastrointestinal haemorrhage: implications for resource utilisation

Area of Science:

• Gastroenterology
• Clinical Medicine
• Epidemiology

Background:

• Acute upper gastrointestinal (GI) bleeding is a significant medical issue with a notable mortality rate.
• Early risk assessment and stratified management are crucial for optimizing patient outcomes and resource utilization.
• The Rockall scoring system, developed in the UK, offers a potential tool for risk stratification.

Purpose of the Study:

• To validate the Rockall scoring system for acute upper GI bleeding in a New Zealand patient population.
• To assess the correlation between the Rockall score and in-hospital mortality risk.
• To determine the utility of the scoring system for guiding management decisions.

Main Methods:

• A prospective study of 565 consecutive patients with acute upper GI bleeding at Wellington Hospital (1988-1991).
• Retrospective assignment of Rockall scores (0-7) based on age, hemodynamic variables, and co-morbidity.
• Correlation analysis between the assigned scores and in-hospital mortality risk.

Main Results:

• The overall 30-day mortality rate was 11%.
• Patients with a low-risk score (<4) had a mortality of 3.2% (60.5% of patients).
• Patients with a high-risk score (4-7) experienced a significantly higher mortality of 22.4% (39.5% of patients).

Conclusions:

• The Rockall scoring system demonstrates validity in the New Zealand population, mirroring UK findings.
• The system effectively stratifies patients into low and high-risk groups for acute upper GI bleeding.
• Adoption of this scoring system can optimize the use of intensive care resources by identifying high-risk individuals.