title: Management of patients with nonvariceal upper gastrointestinal hemorrhage before and after the adoption of the Rockall score, in the Italian Gastroenterology Units.
abstract: OBJECTIVE
  Nonvariceal upper gastrointestinal hemorrhage is a frequent reason for ordinary hospital admission. In Italy the use of prognostic scores to stratify the risk has not been adequately validated: the impact on clinical management of a rating system like the Rockall score remains to be established. RING is a 'register' that has been collecting hospital discharge files from hospital gastroenterology units, giving a broad picture of the patients admitted for this pathology.
  
  
  METHODS
  We analyzed the hospital discharge files collected between 2001 and 2005 from 12 gastroenterology units, which issued more than 26,000 hospital discharge files for ordinary hospital admission and have been using the Rockall score for defining nonvariceal upper gastrointestinal hemorrhage since 2003.
  
  
  RESULTS
  There were 2832 hospital discharge files with a main diagnosis of nonvariceal upper gastrointestinal hemorrhage: 1335 'before' the Rockall score was introduced, 1497 'after' the introduction. Patients' mean age was 67.7+/-16.7 years, with a male/female ratio of 1.7 and no significant changes over the years. There were no differences in the distribution of diagnoses in nonvariceal upper gastrointestinal hemorrhage patients before/after the introduction of the Rockall score, though the mean hospital stay became shorter (7.1+/-5.0 vs. 6.3+/-4.5 days), and mortality declined (2.8 vs. 2.3%), in parallel with the caselist as a whole. For 1102 ordinary hospital admission Rockall score was calculated. Diagnoses were more accurate: significantly fewer undefined causes and an increase in peptic ulcer. The mean Rockall score was 4.6+/-2.2: 17.8% low (0-2), 48.7% intermediate (3-5), and 33.5% high (>or=6). Mean hospital stay, rebleeding, and mortality were correlated with the severity of the score.
  
  
  CONCLUSIONS
  The Rockall score enables the clinician to formulate a more precise diagnosis and substantially shortens the time in hospital, especially for patients at low-risk of rebleeding and death, so more resources can be dedicated to critically ill patients.
authors.affiliation: Gastroenterology, S. Carlo Borromeo Hospital, Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Soncini
authors.forename: Omero
authors.initials: O
authors.lastname: Triossi
authors.forename: Pietro
authors.initials: P
authors.lastname: Leo
authors.forename: Giovanna
authors.initials: G
authors.lastname: Magni
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Bertelè
authors.forename: Tiziana
authors.initials: T
authors.lastname: Grasso
authors.forename: Luca
authors.initials: L
authors.lastname: Ferraris
authors.forename: Stefano
authors.initials: S
authors.lastname: Caruso
authors.forename: Antonio
authors.initials: A
authors.lastname: Spadaccini
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Brambilla
authors.forename: Mario
authors.initials: M
authors.lastname: Verta
authors.forename: Rosangela
authors.initials: R
authors.lastname: Muratori
authors.forename: Antonio
authors.initials: A
authors.lastname: Attinà
authors.forename: Gianalberto
authors.initials: G
authors.lastname: Grasso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004381:Duodenal Ulcer / Q000150:complications / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012720:Severity of Illness Index; D013276:Stomach Ulcer / Q000150:complications / Q000175:diagnosis