Background:
Upper gastrointestinal bleeding is a common indication for admission to the hospital. Several risk score systems are designed for triage patients with acute nonvariceal upper gastrointestinal bleeding (UGIB). Glasgow Blatchford score (GBS) and clinical or preendoscopic Rockall score (CRS) use simple clinical factors such as age, evidence of shock, hemoglobin, plasma urea, presence of comorbidity, and presentation with melena or syncope as predictors of outcome. The aim of our study was to compare the GBS and the CRS to predict the need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding.
Methods:
Consecutive adults admitted between December 2006 and June 2010 with UGIB to a tertiary‐care hospital were identified from computerized medical records. Patients with variceal bleeding were excluded. GBS and CRS were calculated for each patient. A high‐risk score was defined as a GBS > 0 and a CRS > 0. Patients were defined as needing clinical intervention if they had a blood transfusion or any operative or endoscopic intervention to control their bleeding.
Results:
A total of 388 adults with UGIB were available for study. The GBS identified 369 (95.1%) of the 388 patients as high risk for clinical intervention. The CRS identified 356 (91.8%) of the 388 patients as high risk. The yield of identifying high‐risk cases with the GBS was significantly greater than that with the CRS (P < 0.0001). Of the total of 388 patients, 266 patients (68.6%) required clinical intervention. The GBS identified 265 (99.6%) of 266 patients as high risk (sensitivity, 99.6%; specificity, 14.8%; positive predictive value, 71.8%; negative predictive value, 94.7%). The single patient not identified via GBS as high risk required endoscopic intervention to stop bleeding but did not have recurrent bleeding or receive blood transfusion. The CRS identified 249 (93.6%) of 266 patients as high risk (sensitivity, 93.6%; specificity, 12.3%; positive predictive value, 69.9%; negative predictive value, 46.9%). Seventeen patients who required clinical intervention were not recognized via CRS. Of these patients, 4 needed endoscopic intervention to stop bleeding, 17 needed blood transfusion, and none developed recurrent bleeding.
Conclusions:
The Glasgow Blatchford score, which is based on clinical and laboratory variables, may be a useful risk‐stratification tool in detecting which patients need clinical intervention in patients with acute nonvariceal UGIB. It does not need urgent endoscopy for scoring and has higher sensitivity than the preendoscopic Rockall score in identifying high‐risk patients.
Disclosures:
A. Zalawadia ‐ none; R. Parekh ‐ none; B. Yaghmour ‐ none; G. Yaghmour ‐none; G Buran ‐ none