title: Effectiveness of an upper-gastrointestinal haemorrhage unit: a prospective analysis of 900 consecutive cases using the Rockall score as a method of risk standardisation.
abstract: OBJECTIVE
  To assess the effectiveness of a centralised upper-gastrointestinal haemorrhage (UGIH) unit.
  
  
  METHODS
  The UK Audit of acute UGIH resulted in the formulation of a simple numerical scoring system. The Rockall score categorises patients by risk factors for death and allows case-mix comparisons. A total of 900 consecutive patients admitted to a UGIH unit between October 1995 and July 1998 were analysed prospectively. Patients were given an initial Rockall score and, if endoscopy was performed, a complete score. This method of risk stratification allowed the proportion of deaths (in our study) to be compared with the National Audit using risk standardised mortality ratios.
  
  
  RESULTS
  The distribution of both initial and final Rockall scores was significantly higher in our study than in the National Audit. A total of 73 (8.1%) patients died, compared with the National Audit mortality of 14%. Risk-standardised mortality ratios using both initial and complete Rockall scores were significantly lower in our study when compared with those in the National Audit.
  
  
  CONCLUSIONS
  A specialised UGIH unit is associated with a lower proportion of deaths from UGIH, despite comprising a greater number of high-risk patients than the National Audit. This lower mortality therefore cannot be attributed to a more favourable case mix and demonstrates that further improvements in mortality for UGIH can be made.
authors.affiliation: Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK. d.s.sanders28@btopenworld.com
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Perry
authors.forename: Simon G W
authors.initials: SG
authors.lastname: Jones
authors.forename: Elaine
authors.initials: E
authors.lastname: McFarlane
authors.forename: Alan G
authors.initials: AG
authors.lastname: Johnson
authors.forename: Dermot C
authors.initials: DC
authors.lastname: Gleeson
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Lobo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004381:Duodenal Ulcer / Q000150:complications / Q000628:therapy; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006748:Hospital Departments / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D013276:Stomach Ulcer / Q000150:complications / Q000628:therapy