Original article
Clinical endoscopy
Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding

https://doi.org/10.1016/j.gie.2013.05.003Get rights and content

Background

Data regarding the utility of the Glasgow-Blatchford bleeding score (GBS) in hospitalized patients with upper GI hemorrhage are limited.

Objective

To evaluate the performance of the GBS in predicting clinical outcomes and the need for interventions in patients with upper GI hemorrhage.

Design

Prospective observational study.

Setting

Single, tertiary-care endoscopic center.

Patients

Between July 2010 and July 2012, 888 consecutive hospitalized patients managed for upper GI hemorrhage were entered into the study.

Intervention

GBS and Rockall scores.

Main Outcome Measurements

GBS and Rockall scores were prospectively calculated. The performance of these scores to predict the need for interventions and outcomes was assessed by using a receiver operating characteristic curve.

Results

Endoscopy was performed in 708 patients (80%). A total of 286 patients (40.3%) required endoscopic therapy, and 29 patients (3.8%) underwent surgery. GBS and post-endoscopy Rockall scores (post-E RS) were superior to pre-endoscopy Rockall scores in predicting the need for endoscopic therapy (area under the curve [AUC] 0.76 vs 0.76 vs 0.66, respectively) and rebleeding (AUC 0.71 vs 0.64 vs 0.57). The GBS was superior to Rockall scores in predicting the need for blood transfusion (AUC 0.81 vs 0.70 vs 0.68) and surgery (AUC 0.71 vs 0.64 vs 0.51). Patients with GBS scores ≤3 did not require intervention.

Limitations

Subjective decision making as to need for endoscopic therapy and blood transfusion.

Conclusion

Compared with post-E RS, the GBS was superior in predicting the need for blood transfusion and surgery in hospitalized patients with upper GI hemorrhage and was equivalent in predicting the need for endoscopic therapy, rebleeding, and death. There are potential cutoff GBS scores that allow risk stratification for upper GI hemorrhage, which warrant further evaluation.

Section snippets

Methods

A prospective study was performed on consecutive hospitalized patients who were referred to the Gastroenterology Service of the Royal Adelaide Hospital for the management of upper GI hemorrhage over 24 months, from July 2010 to July 2012. Upper GI hemorrhage was defined as bleeding from the upper GI tract as manifest by hematemesis (including coffee-ground vomiting) and/or melena. Variceal and nonvariceal causes of upper GI hemorrhage were included in the analysis. Patients were followed during

Results

A total of 888 (560 men; aged 66.2 ± 0.6 years) hospitalized patients were managed for upper GI hemorrhage by the Gastroenterology Service of the Royal Adelaide Hospital over 24 months. The presenting symptoms were melena (n = 467, 52.6%), hematemesis (n = 238, 26.8%), and both hematemesis and melena (n = 183, 20.6%). Endoscopy was performed in 708 patients (79.7%) (459 men; aged 65.6 ± 0.6 years), with 103 patients (11.6%) undergoing repeated endoscopy for rebleeding. Blood transfusion was

Discussion

Our data show that the GBS is superior to the pre-E RS in predicting the need for endoscopic therapy and is superior to both the pre-E and post-E Rockall scores in predicting the need for blood transfusion and surgery in hospitalized patients with upper GI hemorrhage. Our study also shows that a GBS score of ≤3 identifies patients who do not require endoscopic intervention, transfusion, or surgery, suggesting that these patients can be discharged early with conservative management and

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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