title: A survey on mortality from non-variceal upper gastrointestinal bleeding: Is the emergency referral system adequate?
abstract: BACKGROUND
  Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important cause of mortality and morbidity worldwide. Little information is available on the clinical management of non-variceal upper gastrointestinal bleeding in Italy in relation to the current organization of the Italian Emergency Health Services into Level-I and Level-II Emergency Departments (ED), the latter being more complex structures with greater resources.
  
  
  METHODS
  A retrospective survey on clinical, endoscopic, and survival data was conducted by the regional sections of the 3 main Italian gastroenterological societies, AIGO, SIED and SIGE, recording all consecutive episodes of non-variceal upper gastrointestinal bleeding referred to 7 centres (4 of which were Level-II Emergency Departments) in Rome, Italy, during a one-year period. A total of 624 consecutive patients (64% males, mean age 67.6 ± 16.2 years) were included. Thirty-day mortality was 4.6%. Main factors associated with survival at both univariate and multivariate analysis were the presence of full Rockall score <5 and the admission to a Level-II Emergency Departments (p<0.001). Level-I Emergency Departments admitted patients with a full Rockall score ≥ 5 (p=0.02) more frequently than patients with negative endoscopic findings (p<0.001).
  
  
  CONCLUSIONS
  Referral of non-variceal upper gastrointestinal bleeding patients to Emergency Departments with more resources (Level-II) is associated with reduced mortality. Yet, unfortunately, high-risk patients were more often admitted to Level-I Emergency Departments, which suggests the need for a better organization of the emergency referral system.
authors.affiliation: Policlinico Universitario "Agostino Gemelli", Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cesaro
authors.forename: Anna
authors.initials: A
authors.lastname: Kohn
authors.forename: Lucio
authors.initials: L
authors.lastname: Petruziello
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
authors.forename: Francesco
authors.initials: F
authors.lastname: Franceschi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gigliozzi
authors.forename: Antonietta
authors.initials: A
authors.lastname: Lamazza
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tammaro
authors.forename: Sandro
authors.initials: S
authors.lastname: Boschetto
authors.forename: Stefano
authors.initials: S
authors.lastname: Brighi
authors.forename: Angelo
authors.initials: A
authors.lastname: Antoniozzi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Baiocchi
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000601:surgery; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D011379:Prognosis; D012008:Recurrence; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Emergency department; Endoscopy; Gastro-intestinal bleeding