The Relationship between Pre-endoscopic Rockall Score and Clinical Course of Patients Presenting wit Non-Variceal Upper gastrointestinal Bleeding in the Emergency Department

Abstract

Aim: There are several scoring systems used for determining the mortality and surgery need among the patients with gastrointestinal bleeding. Aim of this study is to evaluate the relationship between the preendoscopic Rockall score (PreRS) and clinical outcome of the patients with nonvariceal upper gastrointestinal bleeding admitted to emergency department.

Material and Method: Patients over 18 years of age who admitted to our emergency department due to the nonvariceal upper gastrointestinal bleeding between August 2014 and July 2015 were included in this retrospective study.

Results: A total of 368 patients were included in this study. The mean age of the patients was 63,03±17,43 years of age. According to the calculated PreRS 56 (15,2%) of the patients were at low risk group whereas 312 (84,8%) of patients were at high risk group. The ratio of the patients with endoscopic Forrest IIc and III ulcers in the high risk PreRS group was significantly lower than the low risk PreRS group (p<0,05). The ratio of the patients who were accepted to intensive care unit or died at the emergency department in the high risk PreRS group was significantly higher than the low risk PreRS group (p<0,05). The ratio and number of the blood transfusion in the high risk PreRS group was significantly higher than the low risk PreRS group (p<0,05). The ratios of the patients with surgery need, rebleeding, mortality during hospitalization and the length of hospital stay were not significantly different in both low and high risk PreRS groups (p>0,05).

Conclusion: Despite various restrictions, PreRS is helpful for risk stratification of the patients admitted to the emergency department with nonvariceal upper gastrointestinal bleeding but it is not helpfull in predicting the clinical outcome of these patients. 

Keywords

• Emergency Department,Upper Gastrointestinal Bleeding,Pre-endoscopic Rockall Score

Acil Serviste Non-varisiyel Üst Gastrointestinal Sistem Kanaması ile Başvuran Hastaların Pre-endoskopik Rockall Skorunun Klinik Seyir ile İlişkisi

Abstract

Amaç: Gastrointestinal sistem kanamalarında mortalite ve cerrahiye gidecek hastaların belirlenmesinde birçok skorlama sistemi kullanılmaktadır. Bu çalışmanın amacı acil servise başvuran akut nonvarisiyel üst gastrointestinal sistem kanamalı hastaların preendoskopik Rockall skoru (PreRS)  ile klinik seyri arasındaki ilişkinin değerlendirmektir.

Materyal ve Metod: Ağustos 2014 ve Temmuz 2015 arası acil servisimize başvuran 18 yaş üstü nonvarisiyel üst gastrointestinal sistem kanaması tanısı alan hastalar retrospektif olarak çalışmaya dahil edildi.

Bulgular: Bu çalışmaya toplam 368 hasta dahil edildi. Hastaların ortalama yaşı 63,03±17,43 idi. PreRS’na göre hastaların 56’sı (% 15,2) düşük riskli, 312’si (% 84,8) yüksek riskli grupta idi. PreRS yüksek riskli olan grupta endoskopik Forrest IIc ve III olan hasta oranı PreRS düşük riskli olan gruptan anlamlı (p<0,05) olarak düşük bulundu. Hastaların yoğun bakım yatışı ve acilde exitus oranı PreRS yüksek riskli olan grupta PreRS düşük risk olan gruptan anlamlı (p<0,05) olarak daha yüksek bulundu. PreRS yüksek risk olan grupta kan transfüzyon yapılma oranı ve sayısı PreRS düşük risk olan gruptan anlamlı (p ˂ 0,05) olarak daha yüksek bulundu. PreRS düşük ve yüksek olan grupta cerrahi geçirme, tekrar kanama, yatışta exitus oranları ve yatış süresi anlamlı (p ˃ 0,05) farklılık saptanmadı.

Sonuç: Çeşitli kısıtlılıkları olmasına karşın acil servise başvuran NVÜGK’lı hastaların risk sınıflamasının yapılmasında PreRS faydalı olduğu, ancak seyrin öngörülmesinde yardımcı olmayabileceği söylenebilir.

Keywords

• Acil Servis,Gastrointestinal Kanama,Preendoskopik Rockall skoru

References

1. 1. Lewis JD, Bilker WB, Brensinger C, Farrar JT, Strom BL. Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990s: Relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medications. Am J Gastroenterol 2002; 97:2540-2549.
2. 2. Marx AJ, Hockberger SR, Walls MR. Rosen’s Emergency Medicine. 8th Ed., Philadelphia: Saunders, an imprint of Elsevier Inc, 2014. :248-253.
3. 3. Gilbert DA. Epidemiology of upper gastrointestinal bleeding. Gastrointest Endosc 1990; 36:8-13.
4. 4. Longstreth GF, Feitelberg SP. Outpatient care of selected patients with acute non-variceal upper gastrointestinal haemorrhage. Lancet 1995; 345:108-111.
5. 5. Ferguson CB, Mitchell RM. Nonvariceal upper gastrointestinal bleeding: standard and new treatment. Gastroenterol Clin North Am 2005; 34:607-621.
6. 6. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38:316-321.
7. 7. Ferhat İÇME, et all, Analysis Of Endoscopic And Demographic Data Of The Patients Admitted To The Emergency Department With Non-Variceal Upper Gastrointestinal Bleeding, Turkish Medical Journal 2011:5(1).
8. 8. Hamoui N, Docherty SD, Crookes PF. Gastrointestinal hemorrhage: is the surgeon obsolete. EmergMed Clin North Am 2003; 21(4):1017-1056.

9. 9. Dicu D, Pop F, Ionescu D, et al. Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit. AJEM 2013; 31: 94-99.
10. 10. Worthley DL, Fraser RJ. Management of acute bleeding in the upper gastrointestinal tract. Aust Prescr 2005; 28:62-66.
11. 11. Işık et al. Comparison of some of the scoring systems and mean platelet volume in the prediction of mortality in patients admitted to the emergency department with upper gastrointestinal bleeding AbantMed J 2014;3(3):242-247.
12. 12. Feldman M, Friedman LS, Sleisenger MH. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: pathophysiology, diagnosis, management. 7th ed. , Philadelphia:Saunders:2002.
13. 13. Chen IC, Hung MS, Chiu TF, et al. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. AJEM 2007; 25:774-779.
14. 14. Ginsberg GG, Gostout CJ, Kochman ML, Norton ID. Clinical gastrointestinal endoscopy. 2nd Ed., Philadelphia: Saunders, an imprint of Elsevier Inc, 2012: 128-144.
15. 15. Cander B, Ertekin B, Kara H, Gül M, Dündar D, Koçak S. Acil Servise Gastrointestinal Kanama İle Başvuran Hastalarda Hastane Yatış Süresini Etkileyen Faktörler. Fırat Tıp Dergisi 2011; 16: 54-56.
16. 16. I-Chuan Chen et al. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. American Journal of Emergency Medicine 2007; 25:774–779.
17. 17. Tham TC, James C, Kelly M. Predicting outcome of acute non-variceal upper gastrointestinal haemorrhage without endoscopy using the clinical Rockall score. Postgrad Med J 2006 Nov;82(973):757-9.
18. 18. Custodio LJ, Garcia MC, Kibune NC, et al. Performance of the Rockall scoring system in predicting the need for intervention and outcomes in patients with nonvariceal upper gastrointestinal bleeding in a Brazilian setting:a prospective study. Digestion 2013;88(4):252-7.
19. 19. Meltzer AC, Burnett S, Pinchbeck C, et al. Pre-endoscopic Rockall and Blatchford scores to identify which emergency department patients with suspected gastrointestinal bleed do not need endoscopic hemostasis. J Emerg Med 2013 Jun;44(6):1083-7.
20. 20. Johnston MR, Murray IA, Schultz M, et al. Does preendoscopy Rockall score safely identify low risk patients following upper gastrointestinal haemorrhage? Gastroenterol Res Pract 2015;2015:410702.