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Management of upper GI haemorrhage 1976-1987: a New Zealand regional study
1Endoscopy Department, Palmerston North Hospital, New Zealand.
Insights
A specialized gastroenterology team and established protocols for upper GI bleeding management resulted in a low 4.1% mortality rate. Continuous auditing and protocol updates are crucial for controlling upper gastrointestinal hemorrhage.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Hospital Management
Background:
- Palmerston North Hospital has managed all upper gastrointestinal (GI) bleeding cases since 1960.
- A standardized management protocol was implemented in 1976, including early endoscopy, investigations, and transfusion/surgical criteria.
Purpose of the Study:
- To report the outcomes of upper GI bleeding patients treated under a specialized team and protocol.
- To evaluate the effectiveness of a defined management strategy in reducing mortality.
Main Methods:
- Retrospective analysis of 865 upper GI bleeding patients treated between 1976 and 1989.
- Inclusion of standardized investigations, early endoscopy (within 24 hours), H2 antagonist use, and defined surgical/transfusion criteria.
- Annual audits to monitor performance and outcomes.
Main Results:
- A total of 865 patients were analyzed (512 male, 353 female).
- 7% of cases (61 patients) required urgent surgery.
- A mortality rate of 4.1% (36 patients) was observed, noted as the lowest reported for a large series. Most deaths were due to non-GI causes.
Conclusions:
- A dedicated, specialized team with agreed protocols and interdisciplinary cooperation is essential for controlling upper GI hemorrhage mortality.
- Regular performance audits and protocol revisions based on evolving knowledge and technology are vital.
- The study highlights the success of a structured approach in managing upper GI bleeding.
Abstract:
Since 1960 all cases of upper GI bleeding have been admitted to the GE team at Palmerston North Hospital, a lower North island centre (population 150,000). A management protocol has been established since 1976, with endoscopy within 24 hours, standardised investigations and agreed criteria for transfusion and surgical intervention. since 1978 all cases have been treated with H2 antagonists on admission. An annual audit has been performed to monitor performance. This study outlines the results of 865 patients (M512:F353) treated between 1976 and 1989. 61 cases required urgent surgery (7%), 36 patients died (4.1%)-the lowest reported mortality for any large series. The majority of deaths occurred from non-gastroenterological causes. If the mortality rate from upper GI haemorrhage is to be controlled all cases must be closely supervised by an interested specialised team with agreed protocols and cooperation between medical and surgical specialties. It is important to review performance with a regular audit and protocols need to be revised as technology and knowledge develops.