Management of upper GI haemorrhage 1976–-1987: A New Zealand regional study

Abstract

Since 1960 all cases of upper GI bleeding have been admitted to the GE team at Palmerston North Hospital, a lower North island centre (population 150,000). A management protocol has been established since 1976, with endoscopy within 24 hours, standardised investigations and agreed criteria for transfusion and surgical intervention. since 1978 all cases have been treated with H2 antagonists on admission. An annual audit has been performed to monitor performance. This study outlines the results of 865 patients (M512:F353) treated between 1976 and 1989. 61 cases required urgent surgery (7%), 36 patients died (4.1%)-the lowest reported mortality for any large series. The majority of deaths occurred from non-gastroenterological causes. If the mortality rate from upper GI haemorrhage is to be controlled all cases must be closely supervised by an interested specialised team with agreed protocols and cooperation between medical and surgical specialties. It is important to review performance with a regular audit and protocols need to be revised as technology and knowledge develops.