Dedicated bleed units: should they be advocated?
BACKGROUND
Upper gastrointestinal haemorrhage (UGIH) is a common emergency, however, dedicated bleed units only exist in selected hospitals in the UK.


OBJECTIVE
To evaluate the rebleeding and mortality rate of patients admitted with UGIH to a tertiary centre bleed unit in comparison with the current national standards and earlier unit performance in 1995-1998.


METHODS
A retrospective case note review of demographics, the Rockall scores and final outcome was conducted for all patients admitted to the bleed unit over 24 months.


RESULTS
Two hundred and fifty-five cases were identified with a mean age of 62 years and a median Rockall score of 3. Eighty-two percent of gastroscopies were performed within 24 h. Of these, 29% were undertaken after 5 p.m. Peptic ulcer and varices (15%) were the commonest diagnosis. The rebleeding (12%) and mortality rate (9%) were comparable with that of the units previous audit (P=0.47, 0.51, respectively) and the current national audit (P=0.58, 0.76, respectively). The number of patients requiring surgery has reduced from 6 to 0.4% in our unit over the last 8 years. Preendoscopy and postendoscopy Rockall scores were predictive of rebleeding (P=0.013, 0.045) and mortality (P=0.003, 0.01).


CONCLUSIONS
This study has shown a consistently low rebleeding and mortality rate in patients with UGIH in a dedicated bleed unit. However there are limitations to the degree of improvements which can be demonstrated due to factors such as age and comorbidity.
Sidhu
Reena
R
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Trust, UK. reena_sidhu@yahoo.com
Sakellariou
Paraskevi
P
McAlindon
Mark E
ME
Donnelly
Mark T
MT
Johal
Shawinder S
SS
Sanders
David S
DS
D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D005773:Gastroscopy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom