title: Does Preendoscopy Rockall Score Safely Identify Low Risk Patients following Upper Gastrointestinal Haemorrhage?
abstract: Objective. To determine if preendoscopy Rockall score (PERS) enables safe outpatient management of New Zealanders with upper gastrointestinal haemorrhage (UGIH). Methods. Retrospective analysis of adults with UGIH over 59 consecutive months. PERS, diagnosis, demographics, need for endoscopic therapy, transfusion or surgery and 30-day mortality and 14-day rebleeding rate, and sensitivity and specificity of PERS for enabling safe discharge preendoscopy were calculated. Results. 424 admissions with UGIH. Median age was 74.3 years (range 19-93 years), with 55.1% being males. 30-day mortality was 4.6% and 14-day rebleeding rate was 6.0%. Intervention was required in 181 (46.6%): blood transfusion (147 : 37.9%), endoscopic intervention (75 : 19.3%), and surgery (8 : 2.1%). 42 (10.8%) had PERS = 0 with intervention required in 15 (35.7%). Females more frequently required intervention, OR 1.73 (CI: 1.12-2.69). PERS did not predict intervention but did predict 30-day mortality: each point increase equated to an increase in mortality of OR 1.46 (CI: 1.11-1.92). Taking NSAIDs/aspirin reduced 30-day mortality, OR 0.22 (CI: 0.08-0.60). Conclusion. PERS identifies 10.8% of those with UGIH as low risk but 35.7% required intervention or died. It has a limited role in assessing these patients and should not be used to identify those suitable for outpatient endoscopy.
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Johnston
authors.affiliation: Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, 201 Great King Street, Dunedin 9016, New Zealand ; Department of Gastroenterology, Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK.
authors.forename: Iain A
authors.initials: IA
authors.lastname: Murray
authors.affiliation: Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, 201 Great King Street, Dunedin 9016, New Zealand ; Department of Medicine, Dunedin School of Medicine, University of Otago, unedin 9054, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Schultz
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: McLeod
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Nathan
authors.initials: N
authors.lastname: O'Donnell
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Heather
authors.initials: H
authors.lastname: Norton
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Baines
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Emily
authors.initials: E
authors.lastname: Fawcett
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Terry
authors.initials: T
authors.lastname: Fesaitu
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Hin
authors.initials: H
authors.lastname: Leung
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Jeong-Yoon
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Adibah
authors.initials: A
authors.lastname: Salleh
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
authors.forename: José A
authors.initials: JA
authors.lastname: García