Effectiveness of an upper-gastrointestinal haemorrhage unit: a prospective analysis of 900 consecutive cases using the Rockall score as a method of risk standardisation

Eur J Gastroenterol Hepatol. 2004 May;16(5):487-94. doi: 10.1097/00042737-200405000-00009.


Objectives: To assess the effectiveness of a centralised upper-gastrointestinal haemorrhage (UGIH) unit.

Methods: The UK Audit of acute UGIH resulted in the formulation of a simple numerical scoring system. The Rockall score categorises patients by risk factors for death and allows case-mix comparisons. A total of 900 consecutive patients admitted to a UGIH unit between October 1995 and July 1998 were analysed prospectively. Patients were given an initial Rockall score and, if endoscopy was performed, a complete score. This method of risk stratification allowed the proportion of deaths (in our study) to be compared with the National Audit using risk standardised mortality ratios.

Results: The distribution of both initial and final Rockall scores was significantly higher in our study than in the National Audit. A total of 73 (8.1%) patients died, compared with the National Audit mortality of 14%. Risk-standardised mortality ratios using both initial and complete Rockall scores were significantly lower in our study when compared with those in the National Audit.

Conclusion: A specialised UGIH unit is associated with a lower proportion of deaths from UGIH, despite comprising a greater number of high-risk patients than the National Audit. This lower mortality therefore cannot be attributed to a more favourable case mix and demonstrates that further improvements in mortality for UGIH can be made.

Publication types

  • Evaluation Study

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Duodenal Ulcer / complications
  • Duodenal Ulcer / therapy
  • Female
  • Gastroenterology / standards*
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / therapy*
  • Hospital Departments / standards*
  • Humans
  • Male
  • Medical Audit*
  • Middle Aged
  • Prospective Studies
  • Risk Assessment
  • Stomach Ulcer / complications
  • Stomach Ulcer / therapy