Complete Rockall score in predicting outcomes in acute upper gastrointestinal bleeding

Abstract

Background: Acute upper GI bleeding is a common medical emergency with a hospital mortality of approximately 10%. Higher mortality rate is associated with re-bleedinging. Complete Rockall scoring system identifies patients at higher risk of re-bleeding and mortality. Materials and Methods: This is a descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to December 2014. It included 200 patients at random presenting with manifestations of UGI bleed. Complete Rockall score was calculated in each patient and its correlation with mortality and re-bleeding was determined. Scores of >5 has been considered as one category as it comprises of patients with very high risks and scores of 0-4 as another category of low or lesser risks for the purpose of comparison of different risk factors. Results: Males were predominant (71%). Age ranged from 14 to 90 years, mean being 50.43+17.75 years. At presentation 110 patients (55%) had both hematemesis and malena, 56 patients (28%) had only malena and 34 patients (17%) had only hematemesis. Shock was detected in 21%, severe anemia and high blood urea were found in 31% and 41% respectively. Median hospital stay was 6.5+3.10 days. Comorbidities were present in 83.3%. Complete Rockall score ranged from 0 to 9, mean being 4.30+2.19. One hundred and thirteen (56.5%) had complete Rockall score <4 and 87 (43.5%) >5. Re-bleeding was found in 16 (8%) patients. One hundred and eighty eight patients (94%) recovered and discharged from the hospital and 12 patients (6%) expired. The correlations between high Rockall scores (>5) and the occurrence of re-bleeding (p=0.001) and mortality (p=0.001) were statistically significant. Conclusions: Acute Upper GI bleeding is a medical emergency. Predictors of mortality in this series were high complete Rockall score >5, esophageal varices with Child Pugh score C, massive initial bleed as well as re-bleed and multiple co-morbidities.

Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

“…Mean arterial blood pressure was low (73.71±10.95) 12 and hypotension was noted in 14.8% 18 of patients at presentation. Patients were anemic in 16.5% in our study but in other studies, it was reported in 31% 19 of patients being severely anemic.…”

“…17 In our study, 22.3% of patients received a blood transfusion. A higher percentage of blood transfusion in 77% 8 , 69.5% 18 , and 51.92% 19 have been reported in other studies.…”

Application effect of nursing model based on Rockall scoring system in emergency endoscopic treatment for patients with gastrointestinal bleeding

“…The Rockall scoring system is a comprehensive analysis of age, shock index, complications and other indicators of patients to accurately identify the potential bleeding risk of patients and effectively improve the prognosis. Studies have indicated that the Rockall score has been confirmed to be an accurate predictor of rebleeding and death [7]. Therefore, effective risk stratification of gastrointestinal bleeding by the Rockall score can help identify high-risk patients, thereby conducting closer monitoring, faster response, and improvement of prognosis [8].…”

Modified Rockall score: a predictor for outcome in patients presenting with upper gastrointestinal bleed

“…Upper gastrointestinal bleeding (UGIB) is a lifethreatening condition and requires careful evaluation from the very first episode as an attempt to predict and reduce the risk of re-bleeding and death. 8 Several riskscoring systems exist to assess patients presenting with upper gastrointestinal hemorrhage.…”