PTU-025 How accurately is rockall score calculated for patients with acute upper gastrointestinal bleeding (AUGIB)?

Abstract

Introduction Documentation of Rockall score (RS) in patients with AUGIB should be accurate in order to prioritise patients for gastroscopy. We conducted a pilot study in 2012 which showed that RS was calculated incorrectly in 46% patients. We investigated this further with a larger cohort of patients. Method Information was collected retrospectively on patients who presented with presented with AUGIB from February 2012 to February 2013. Patients who had out-of-hours gastroscopy excluded. Demographics, time to perform gastroscopy, RS documented by the doctor requesting the gastroscopy, RS calculated by analysing patient records (including A&E, paramedic records) were collected. We analysed patients whose RS was either underscored or overscored by the requesting doctor (this was compared to the actual score calculated by us) and correlated the calculated RS with the need for endoscopic intervention. Results There were 248 patients with 149 (60%) males, age 16 to 98 years (mean 69). Presenting symptoms were melaena in 129 (51%), haemetemesis 35 (14%), coffee ground vomiting 64 (25%), rectal bleed 17 (7%), melaena and haematemesis 4. RS was calculated incorrectly in 194 (78%) patients with 110 (44%) over scored (Group A), 84 (34%) underscored (Group B). Mean RS on request form for Group A patients was 3.64 ± 1.97 while the calculated RS was 1.85 ± 1.61. In Group B, mean RS documented was 1.8 ± 0.96 while the calculated RS was 3.9 ± 1.04. Mean time from electronic booking to gastroscopy was 2.02 days – 1.67 days for Group A and 2.04 days in Group B. FY1s calculated incorrect scores in 83 (43%) patients, FY2s in 20 (10%), SHOs in 81 (42%), registrars in 7 (4%) and consultants 3 (2%). Of the 111 FY1s (45%) who calculated the RS, 46 (41%) overscored, 37 (33%) underscored and 28 (25%) calculated RS correctly. The numbers for 27 FY2 (11%) were 11 (41%), 9 (33%) and 7 (26%) respectively. Of the 95 (38%) SHOs, 47 (50%) overscored, 34 (36%) underscored and 14 (15%) calculated RS correctly. There were 11 specialist registrars (4 correct, 4 overscored and 3 underscored) and 4 Consultant request forms (3 incorrect). Of the 248 patients, 37 (15%) required endoscopic intervention. In Group A, 16 (15%) needed endoscopic intervention, compared to 11 (13%) in Group B. Ten (19%) of the 54 patients scored correctly required endoscopic therapy. Conclusion This study shows that it is important to document the RS at the time of first presentation of AUGIB rather than at the time when the patient is seen by the admitting doctor. This study however does not show a direct correlation between the RS and endoscopic intervention. It emphasises the fact that all doctors should be educated about the importance of documenting the correct RS as more than three quarter of the RS on request forms were found to be inaccurate. Disclosure of interest None Declared.