Utilization of health care resources for low-risk patients with acute, nonvariceal upper GI hemorrhage: an historical cohort study.
BACKGROUND
Adults hospitalized with acute, nonvariceal upper GI hemorrhage can be accurately stratified according to their risk of subsequent adverse outcomes by using the Rockall score. Low-risk patients (Rockall score less-than-or-equal 2) may be candidates for early discharge.


METHODS
Cases were identified with ICD-9-CM codes for calendar years 1997 and 1998. Medical record data to determine patient Rockall risk score, health care resource utilization, and adverse outcomes were abstracted with standardized forms.


RESULTS
Fifty-three of 175 (30%) cases had Rockall scores < or =2. As predicted, those patients with Rockall scores < or =2 had a low risk of adverse outcomes with only 2 of 53 (4%) meeting criteria for recurrent bleeding as defined by the "Rebleed" variable, and no mortality. These low-risk patients had a mean hospital stay of 2.6 plus minus 2.1 days; 49% were admitted to an intermediate or intensive care unit bed and 57% were given H2 receptor antagonists intravenously.


CONCLUSIONS
The proportion of patients admitted with acute, nonvariceal, upper GI hemorrhage with Rockall Scores < or =2 was substantial. Adverse outcomes were rare. In contrast, the level of health care resource utilization appeared high. The Rockall score has potential as a clinically based concurrent decision rule to improve the quality of care by finding those patients less likely to require intensive health care services.
Dulai
Gareth S
GS
Department of Medicine, Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA 90073, USA.
Gralnek
Ian M
IM
Oei
Tommy T
TT
Chang
Dong
D
Alofaituli
Gwen
G
Gornbein
Jeff
J
Kahn
Katherine
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016145:Endoscopy, Digestive System; D004941:Esophagitis / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000145:classification* / Q000453:epidemiology / Q000209:etiology; D006295:Health Resources / Q000706:statistics & numerical data*; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D013276:Stomach Ulcer / Q000150:complications
D006635:Histamine H2 Antagonists