Utilization of health care resources for low-risk patients with acute, nonvariceal upper GI hemorrhage: an historical cohort study

Background: Adults hospitalized with acute, nonvariceal upper GI hemorrhage can be accurately stratified according to their risk of subsequent adverse outcomes by using the Rockall score. Low-risk patients (Rockall score: 2) may be candidates for early discharge. Methods: Cases were identified with ICD-9-CM codes for calendar years 1997 and 1998. Medical record data to determine patient Rockall risk score, health care resource utilization, and adverse outcomes were abstracted with standardized forms. Results: Fifty-three of 175 (30%) cases had Rockall scores less than or equal to2. As predicted, those patients with Rockall scores less than or equal to2 had a low risk of adverse outcomes with only 2 of 53 (4%) meeting criteria for recurrent bleeding as defined by the "Rebleed" variable, and no mortality. These low-risk patients had a mean hospital stay of 2.6 +/- 2.1 days; 49% were admitted to an intermediate or intensive care unit bed and 57% were given H-2 receptor antagonists intravenously. Conclusions: The proportion of patients admitted with acute, nonvariceal, upper GI hemorrhage with Rockall Scores less than or equal to2 was substantial. Adverse outcomes were rare. In contrast, the level of health care resource utilization appeared high. The Rockall score has potential as a clinically based concurrent decision rule to improve the quality of care by finding those patients less likely to require intensive health care services.