Three-year prospective validation of a pre-endoscopic risk stratification in patients with acute upper-gastrointestinal haemorrhage.
OBJECTIVE
To assess the accuracy of a risk stratification that is used at initial assessment to identify groups with increased risk of mortality and requirement for urgent treatment intervention.


METHODS
Prospective assessment of risk stratification in consecutive patients with acute upper-gastrointestinal haemorrhage.


METHODS
Over a 3-year period, 1349 consecutive patients with acute upper-gastrointestinal haemorrhage presenting to a single teaching hospital were prospectively risk stratified before endoscopy and followed up for outcome.


METHODS
Two-week, all-cause mortality, re-bleeding, and need for urgent treatment intervention.


RESULTS
Stratification within the high-risk group predicted a significant increased risk of 2-week, all-cause mortality (P < 0.001) when compared with intermediate- and low-risk patients (11.8%, 3% and 0%, respectively), re-bleeding (P < 0.001) (44.1%, 2.3% and 0%, respectively), and need for urgent treatment intervention (P < 0.001) (71%, 40.6% and 2.6%, respectively).


CONCLUSIONS
Over a 3-year period, medical staff at this institution have routinely used this risk stratification, which identifies groups of patients at high and low risk of mortality, re-bleeding and need for urgent treatment intervention following acute upper-gastrointestinal haemorrhage. Use of this risk stratification should allow targeting of more intensive treatment where it might be of most benefit. Those patients at lowest risk from outpatient management are also identified.
Cameron
Ewen A
EA
Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK.
Pratap
J Nick
JN
Sims
Tracey J
TJ
Inman
Simone
S
Boyd
Donna
D
Ward
Maureen
M
Middleton
Stephen J
SJ
D000208:Acute Disease; D000368:Aged; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000628:therapy; D016558:Hemostasis, Endoscopic; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors