Management of acute upper gastrointestinal bleeding in a district hospital.
BACKGROUND
This study was conducted to assess the management of acute upper gastrointestinal bleeding in a district hospital and to compare these results with national guidelines and the published literature.


METHODS
This prospective and retrospective study included 112 patients, mean age 66 years, who presented with acute upper gastrointestinal bleeding between July 2004 and February 2005. All patients were assigned a Rockall risk assessment score.


RESULTS
The surgical on-call teams managed all the patients according to an agreed protocol. Forty-nine patients had a Rockall score > or =4. Endoscopy was performed in all patients, with 60% accomplished within the first 24 hours. The most common cause found was peptic ulcer (30%). Therapeutic endoscopy was undertaken in 10 patients (9%) with a success rate of 70%. Open surgery was performed in 3 patients. One patient died after having surgery and the Rockall score was >5. Of the patients admitted with acute upper gastrointestinal bleeding, 90.2% were discharged without complication. Eleven patients died (9.8%) and all of them from the high risk group with Rockall scores > or =5. Their mean hospital stay was 17.8 days (range, 2-43 days).


CONCLUSIONS
High-standard results in acute upper gastrointestinal bleeding can be achieved in a district hospital. The management, including the use of the operating theater facilities with operative and anesthetic support, was safe and efficient. A 24-hour-a-day endoscopy service is important to achieve early diagnosis and to plan management. A protocol and early endoscopy improve clinical outcome and reduce mortality, which occurred mostly among elderly patients with high risk scores. It is advisable to introduce the Rockall scoring system in practice.
Kasem
Abdul M
AM
Princess Royal University Hospital, Farnborough Common, United Kingdom. abkasem@doctors.net.uk
Kamal
Tamer
T
Chandra
Nanjanagud N
NN
Dayoub
Iyad
I
Munyira
Hudson
H
El-Hasani
Shamsi
S
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D016558:Hemostasis, Endoscopic / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D041742:Upper Gastrointestinal Tract / Q000601:surgery*