A survey on mortality from non-variceal upper gastrointestinal bleeding: Is the emergency referral system adequate?

作者：Cesaro Paola; Kohn Anna; Petruziello Lucio; Angelico Mario; Franceschi Francesco; Gigliozzi Alessandro; Lamazza Antonietta; Tammaro Leonardo; Boschetto Sandro; Brighi Stefano; Antoniozzi Angelo; Baiocchi Leonardo^*

来源：Digestive and Liver Disease, 2013, 45(11): 953-956.

DOI：10.1016/j.dld.2013.04.010

• Emergency department
• Endoscopy
• Gastro-intestinal bleeding

Background: Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important cause of mortality and morbidity worldwide. Little information is available on the clinical management of non-variceal upper gastrointestinal bleeding in Italy in relation to the current organization of the Italian Emergency Health Services into Level-I and Level-II Emergency Departments (ED), the latter being more complex structures with greater resources. %26lt;br%26gt;Methods: A retrospective survey on clinical, endoscopic, and survival data was conducted by the regional sections of the 3 main Italian gastroenterological societies, AIGO, SIED and SIGE, recording all consecutive episodes of non-variceal upper gastrointestinal bleeding referred to 7 centres (4 of which were Level-II Emergency Departments) in Rome, Italy, during a one-year period. A total of 624 consecutive patients (64% males, mean age 67.6 +/- 16.2 years) were included. Thirty-day mortality was 4.6%. Main factors associated with survival at both univariate and multivariate analysis were the presence of full Rockall score %26lt;5 and the admission to a Level-II Emergency Departments (p %26lt; 0.001). Level-I Emergency Departments admitted patients with a full Rockall score %26gt;= 5 (p = 0.02) more frequently than patients with negative endoscopic findings (p %26lt; 0.001). %26lt;br%26gt;Conclusions: Referral of non-variceal upper gastrointestinal bleeding patients to Emergency Departments with more resources (Level-II) is associated with reduced mortality. Yet, unfortunately, high-risk patients were more often admitted to Level-I Emergency Departments, which suggests the need for a better organization of the emergency referral system.

• 出版日期2013-11