Acil Serviste Non-varisiyel Üst Gastrointestinal Sistem Kanaması ile Başvuran Hastaların Pre-endoskopik Rockall Skorunun Klinik Seyir ile İlişkisi

Amaç: Gastrointestinal sistem kanamalarında mortalite ve cerrahiye gidecek hastaların belirlenmesinde birçok skorlama sistemi kullanılmaktadır. Bu çalışmanın amacı acil servise başvuran akut nonvarisiyel üst gastrointestinal sistem kanamalı hastaların preendoskopik Rockall skoru (PreRS) ile klinik seyri arasındaki ilişkinin değerlendirmektir. Materyal ve Metod: Ağustos 2014 ve Temmuz 2015 arası acil servisimize başvuran 18 yaş üstü nonvarisiyel üst gastrointestinal sistem kanaması tanısı alan hastalar retrospektif olarak çalışmaya dahil edildi. Bulgular: Bu çalışmaya toplam 368 hasta dahil edildi. Hastaların ortalama yaşı 63,03±17,43 idi. PreRS’na göre hastaların 56’sı (% 15,2) düşük riskli, 312’si (% 84,8) yüksek riskli grupta idi. PreRS yüksek riskli olan grupta endoskopik Forrest IIc ve III olan hasta oranı PreRS düşük riskli olan gruptan anlamlı (p<0,05) olarak düşük bulundu. Hastaların yoğun bakım yatışı ve acilde exitus oranı PreRS yüksek riskli olan grupta PreRS düşük risk olan gruptan anlamlı (p<0,05) olarak daha yüksek bulundu. PreRS yüksek risk olan grupta kan transfüzyon yapılma oranı ve sayısı PreRS düşük risk olan gruptan anlamlı (p ˂ 0,05) olarak daha yüksek bulundu. PreRS düşük ve yüksek olan grupta cerrahi geçirme, tekrar kanama, yatışta exitus oranları ve yatış süresi anlamlı (p ˃ 0,05) farklılık saptanmadı. Sonuç: Çeşitli kısıtlılıkları olmasına karşın acil servise başvuran NVÜGK’lı hastaların risk sınıflamasının yapılmasında PreRS faydalı olduğu, ancak seyrin öngörülmesinde yardımcı olmayabileceği söylenebilir.

Anahtar Kelimeler:

Acil Servis, Gastrointestinal Kanama, Preendoskopik Rockall skoru

The Relationship between Pre-endoscopic Rockall Score and Clinical Course of Patients Presenting wit Non-Variceal Upper gastrointestinal Bleeding in the Emergency Department

Aim: There are several scoring systems used for determining the mortality and surgery need among the patients with gastrointestinal bleeding. Aim of this study is to evaluate the relationship between the preendoscopic Rockall score (PreRS) and clinical outcome of the patients with nonvariceal upper gastrointestinal bleeding admitted to emergency department. Material and Method: Patients over 18 years of age who admitted to our emergency department due to the nonvariceal upper gastrointestinal bleeding between August 2014 and July 2015 were included in this retrospective study. Results: A total of 368 patients were included in this study. The mean age of the patients was 63,03±17,43 years of age. According to the calculated PreRS 56 (15,2%) of the patients were at low risk group whereas 312 (84,8%) of patients were at high risk group. The ratio of the patients with endoscopic Forrest IIc and III ulcers in the high risk PreRS group was significantly lower than the low risk PreRS group (p<0,05). The ratio of the patients who were accepted to intensive care unit or died at the emergency department in the high risk PreRS group was significantly higher than the low risk PreRS group (p<0,05). The ratio and number of the blood transfusion in the high risk PreRS group was significantly higher than the low risk PreRS group (p<0,05). The ratios of the patients with surgery need, rebleeding, mortality during hospitalization and the length of hospital stay were not significantly different in both low and high risk PreRS groups (p>0,05). Conclusion: Despite various restrictions, PreRS is helpful for risk stratification of the patients admitted to the emergency department with nonvariceal upper gastrointestinal bleeding but it is not helpfull in predicting the clinical outcome of these patients.

Keywords:

Emergency Department, Upper Gastrointestinal Bleeding, Pre-endoscopic Rockall Score,

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