title: Acute nonvariceal upper gastrointestinal bleeding. Care in three different San Diego practice settings.
abstract: We compared the care of all adults admitted directly for acute nonvariceal upper gastrointestinal bleeding in 1981 to three types of hospitals: private (n = 138), health maintenance organization (HMO) (n = 105), and university (n = 72). Some patient characteristics differed, but most indices of blood loss, all final diagnoses, and rates of surgery (less than 9%) and death (less than 5%) were similar. Use of intensive care and blood products differed from published guidelines. Health maintenance organization patients had the shortest stays and the fewest transfusions, limited almost completely to packed red cells. Intensive care unit use and duplicate diagnostic testing were greatest for university patients. Rebleeding rates, determined by including readmissions within 1 week of discharge, were less than 7% and similar at the three institutions. Endoscopic signs of recent hemorrhage from an ulcer were significant signposts to rebleeding. Patients endoscoped early and those without endoscopic signs of recent hemorrhage went home sooner than the others.
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D002140:California; D004724:Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006279:Health Maintenance Organizations; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies