Introduction Acute upper GI bleeding (AUGIB) is a common gastrointestinal problem associated with significant mortality.1 Whilst numerous factors have been shown to influence mortality in these individuals including co-morbidity and time of bleeding, variation in local practises may have a bearing on outcomes. This study evaluates whether facilities provided at differing centres can influence outcomes of AUGIB, with findings compared to the BSG National Audit (Hearnshaw et al 2011).
Methods Data was prospectively collected from five South Yorkshire hospitals (Northern General Hospital, Royal Hallamshire Hospital, Rotherham District General Hospital, Chesterfield Royal Hospital and Barnsley District General Hospital) between Sept-Dec 2011. This included demographic, clinical and endoscopic findings in all AUGIB patients, alongside 30-day mortality outcomes. Patients were risk stratified using pre-endoscopy Rockall scores with comparisons made with national audit results using standardised mortality ratios (SMR). In addition, service provision for AUGIB within each unit was collected. χ2 analysis was used to compare categorical data, with p values < 0.05 considered significant.
Results A total of 796 patients (438 male, median age 65 years, range 16–86) were admitted at all sites with AUGIB during the 3-month study period. Of these patients, 33.7% (268/796) had a pre-endoscopy Rockall score of 6 or above, significantly higher than the 5.9% identified in the national audit (p = < 0.001). All hospitals in South Yorkshire had out of hours (OOH) endoscopy rotas (national audit = 52%), a nurse on call rota (national audit = 37%) and facilities to undertake OOH endoscopy (national audit = 92%). Whilst no statistical difference was identified in mortality between individual hospitals in South Yorkshire (p = 0.406), both risk-standardised mortality ratios and inpatient mortality in South Yorkshire were significantly lower than national audit findings (Table 1).
Conclusion Despite a higher pre-endoscopy Rockall Score in our cohort, both our risk adjusted mortality and inpatient mortality rates were significantly lower than the national audit findings. We believe that these outcomes are reflective of having dedicated GI bleed services, with provision and staffing of OOH endoscopy rotas, enabling us to provide quicker and more comprehensive services to our patients.
Disclosure of Interest None Declared
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