T C K Tham1, C James, M Kelly. 1. Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast BT16 1RH, UK. ttham@utvinternet.com
Abstract
BACKGROUND: The Rockall risk scoring system uses clinical criteria and endoscopy to identify patients at risk of adverse outcomes after acute upper gastrointestinal haemorrhage. A clinical Rockall score obtained using only the clinical criteria may be able to predict outcome without endoscopy. AIM: To validate the clinical Rockall Score in predicting outcome after acute non-variceal upper gastrointestinal haemorrhage. METHODS: A retrospective observational study of consecutive patients who were admitted with non-variceal acute upper gastrointestinal haemorrhage was undertaken. Medical records were abstracted using a standardised form. RESULTS: 102 cases were identified (51 men and 51 women; mean age 59 years). 38 (37%) patients considered to be at low risk of adverse outcomes (clinical Rockall Score 0) had no adverse outcomes and did not require transfusion. Patients with a clinical Rockall Score of 1-3 had no adverse outcomes, although 13 of 45 (29%) patients required blood transfusions. Clinical Rockall Scores >3 (n = 19) were associated with adverse outcomes (rebleeding in 4 (21%), surgery in 1 (5%) and death in 2 (10%)). CONCLUSIONS: The clinical Rockall Score without endoscopy may be a useful prognostic indicator in this cohort of patients with acute non-variceal upper gastrointestinal haemorrhage. This score may reduce the need for urgent endoscopy in low-risk patients, which can instead be carried out on a more elective outpatient basis.
BACKGROUND: The Rockall risk scoring system uses clinical criteria and endoscopy to identify patients at risk of adverse outcomes after acute upper gastrointestinal haemorrhage. A clinical Rockall score obtained using only the clinical criteria may be able to predict outcome without endoscopy. AIM: To validate the clinical Rockall Score in predicting outcome after acute non-variceal upper gastrointestinal haemorrhage. METHODS: A retrospective observational study of consecutive patients who were admitted with non-variceal acute upper gastrointestinal haemorrhage was undertaken. Medical records were abstracted using a standardised form. RESULTS: 102 cases were identified (51 men and 51 women; mean age 59 years). 38 (37%) patients considered to be at low risk of adverse outcomes (clinical Rockall Score 0) had no adverse outcomes and did not require transfusion. Patients with a clinical Rockall Score of 1-3 had no adverse outcomes, although 13 of 45 (29%) patients required blood transfusions. Clinical Rockall Scores >3 (n = 19) were associated with adverse outcomes (rebleeding in 4 (21%), surgery in 1 (5%) and death in 2 (10%)). CONCLUSIONS: The clinical Rockall Score without endoscopy may be a useful prognostic indicator in this cohort of patients with acute non-variceal upper gastrointestinal haemorrhage. This score may reduce the need for urgent endoscopy in low-risk patients, which can instead be carried out on a more elective outpatient basis.
Authors: Douglas G Adler; Jonathan A Leighton; Raquel E Davila; William K Hirota; Brian C Jacobson; Waqar A Qureshi; Waqar A Quereshi; Elizabeth Rajan; Marc J Zuckerman; Robert D Fanelli; R David Hambrick; Todd Baron; Douglas O Faigel Journal: Gastrointest Endosc Date: 2004-10 Impact factor: 9.427
Authors: J G Lee; S Turnipseed; P S Romano; H Vigil; R Azari; N Melnikoff; R Hsu; D Kirk; P Sokolove; J W Leung Journal: Gastrointest Endosc Date: 1999-12 Impact factor: 9.427
Authors: A Koch; L Buendgens; H Dückers; J Bruensing; M Matthes; J Kunze; H H Lutz; T Luedde; J J W Tischendorf; C Trautwein; F Tacke Journal: Med Klin Intensivmed Notfmed Date: 2013-03-17 Impact factor: 0.840