IM Gralnek, VA Greater Los Angeles Healthcare System; GS Dulai, VA Greater Los Angeles Healthcare System; TT Oei, UCLA School of Medicine; D Chang, UCLA School of Medicine; G Alofaituli, UCLA School of Medicine

Objectives: A significant proportion of patients with acute, non-variceal UGIH are at low-risk for adverse outocmes (rebleeding and death). The Rockall Risk Score is a valid, predictive index for stratifying adverse outcomes risk based on clinical (age, co-morbidity, vital signs at presentation) and endoscopic (etiology of bleed, stigmata of recent hemorrhage) criteria. Utilizing the Rockall Risk Score, patients are stratified into low-risk, moderate-risk, or high-risk of potential adverse outcomes. Prolonged hospitalization of patients with "low-risk" Rockall Risk scores may not be justified. The objectives of this study were to 1) identify the incidence of low-risk, non-variceal UGIH admissions to a community hospital in Los Angeles, California during calender years 1997 and 1998, 2) determine the incidence of adverse outcomes, and 3) determine resource utilization for this cohort.

Methods: Cases of acute, non-variceal UGIH were identified using ICD-9 codes for discharge diagnosis. Medical records were abstracted using a standardized data form. SAS was used for data management and analyses.

Results: Of 281 cases identified, 9 patient charts could not be obtained and 85 cases were excluded (lower GI hemorrhage, no endoscopy performed, in-hospital bleed, transfer from other facility) leaving 187 cases of acute, non-variceal UGIH for analysis. 101/187 (54%) were men. Mean age = 68 years. 49 (26%) were low-risk, 93 (50%) were moderate-risk, and 45 (24%) were high-risk patients for adverse outcomes by Rockall Risk Score. 27% used ASA and 25% used NSAIDs. 138 (74% of entire cohort and 51% of low-risk patients) were admitted to an ICU or monitored bed. Most common diagnoses of UGIH included gastric ulcer in 48 (26%) and duodenal ulcer in 37 (20%). Among the Rockall low-risk patients, outcomes were as follows: 9/49 (18%) received blood transfusions after endoscopy, yet only 2/49 (4%) required repeat endoscopy, 1/49 (2%) required surgery, 1/49 (2%) had evidence of rebleed within 30 days after hospital discharge, 0/49 (0%) required hospital readmission within 30 days after discharge, and 0/49 (0%) died. Moreover, low-risk patients had a mean HLOS = 3.3 days as compared to 4.4 days and 6.1 days for moderate-risk and high-risk patients respectively.

Conclusions: Incidence of Rockall low-risk, non-variceal UGIH admissions in a community hospital setting is high (26%), while adverse outcomes are rare. Utilization of health care resources, including level of care at the time of hospital admission and HLOS appears excessive and may be unwarranted for this low-risk cohort.

Impact: 1) Providers (gastroenterologists and primary care physicians) must be taught to risk stratify patients with acute, non-variceal UGIH using valid, simple decision tools (e.g., Rockall Risk Score) as supplements to clinical judgment, 2) Providers should use these risk estimates to make informed decisions about the utilization of health care resources, and 3) Future studies must document outcomes and resource utilization for Rockall "low-risk" patients in other clinical settings including VA.