UPPER GI HEMORRHAGE; To predict the frequency of rebleeding by pre-endoscopic clinical rockall scoring system in patients

摘要

Objectives: To predict the frequency of rebleeding by pre-endoscopic clinicalRockall scoring system in patients presenting with upper gastrointestinal hemorrhage. StudyDesign: Descriptive Case series study. Period: six months. Settings: Departments of Medicine,Liaquat University of Medical and Health sciences Jamshoro/Hyderabad. Material & Methods:The source of data was 187 patients who reported with the presenting complaint of hematemesisin ER and were then transferred to Medical Unit for further management. At the time of inclusionthe concerned Physician collected the demographic data, vital and relevant information for thepresence of co morbidities. After admission patients were shifted to endoscopy suite (situatedin Medical Unit) for the endoscopic diagnosis of the underlying condition. Any new episode ofhematemesis was considered as a re-bleed (within 120 hours of time zero). Rockall scoringwas calculated as per operational definition in the specifically designed proforma for the study.Mortality was noticed in the time the patient stayed in the hospital. Rebleeding was the endpoint of this study. Results: A total of 187 patients were selected for this study. Out of these 119were males (63.64%) and 68 (36.36%) were females. The mean age of patients was 59.25 years± 10.3 SD. Mean systolic BP was 107.08 ± 13.3, heart rate was 90.3 ± 11.9 and clinical Rockallscore of 3.5 ± 0.8 SD. A total of 111 (59.4%) patients presented with bleeding esophagealvarices, 36 (19.3%) presented with bleeding gastric varices, together chronic liver diseasewas responsible for 78.4% (147) of patients. Gastric erosions were seen to be the cause ofupper gastrointestinal hemorrhage in 18 (9.6%) of patients, whereas peptic ulcer disease wasthe cause responsible in 20 (10.7%). Lastly gastric carcinoma was seen in only 2 (1.1%) ofpatients. A total of 35 (18.7%) of patients experienced rebleeding episodes during the hospitalstay. Mortality was seen in 31 patients (16.6%). Conclusion: Clinical Rockall score is a goodpredictor of rebleeding and mortality. However, application of this score for the purpose oftriage of patients reporting with bleeding esophageal varices is problematic because this grouphas the presentation of liver failure along with hematemesis so getting low Rockall scores (andpredicting survival without endoscopic intervention) is not possible in this group of patients.