HFR-5 Increasing the low-risk threshold for patients with upper gastrointestinal bleeding during the COVID-19 pandemic

ObjectiveDuring the COVID-19 pandemic, we extended the low-risk threshold for patients not requiring inpatient endoscopy for upper gastrointestinal bleeding (UGIB) from Glasgow Blatchford Score (GBS) 0–1 to GBS 0–3. We studied the safety and efficacy of this change.MethodsBetween 1 April 2020 and 30 June 2020 we prospectively collected data on consecutive unselected patients with UGIB at five large Scottish hospitals. Primary outcomes were length of stay, 30-day mortality and rebleeding. We compared the results with prospective prepandemic descriptive data.Results397 patients were included, and 284 index endoscopies were performed. 26.4% of patients had endoscopic intervention at index endoscopy. 30-day all-cause mortality was 13.1% (53/397), and 33.3% (23/69) for pre-existing inpatients. Bleeding-related mortality was 5% (20/397). 30-day rebleeding rate was 6.3% (25/397). 84 patients had GBS 0–3, of whom 19 underwent inpatient endoscopy, 0 had rebleeding and 2 died. Compared with prepandemic data in three centres, there was a fall in mean number of UGIB presentations per week (19 vs 27.8; p=0.004), higher mean GBS (8.3 vs 6.5; p<0.001) with fewer GBS 0–3 presentations (21.5% vs 33.3%; p=0.003) and higher all-cause mortality (12.2% vs 6.8%; p=0.02). Predictors of mortality were cirrhosis, pre-existing inpatient status, age >70 and confirmed COVID-19. 14 patients were COVID-19 positive, 5 died but none from UGIB.ConclusionDuring the pandemic when services were under severe pressure, extending the low-risk threshold for UGIB inpatient endoscopy to GBS 0–3 appears safe. The higher mortality of patients with UGIB during the pandemic is likely due to presentation of a fewer low-risk patients.

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THE SOONER, THE BETTER: EARLY ENDOSCOPY IS ASSOCIATED WITH LOWER 30-DAY MORTALITY IN LOW-RISK NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING PATIENTS

10.1055/s-0040-1704182 ◽

2020 ◽

Author(s):

M Freitas ◽

TC Gonçalves ◽

C Marinho ◽

J Cotter

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Low Risk ◽

Early Endoscopy ◽

Upper Gastrointestinal

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Semiautomated Glasgow-Blatchford Bleeding Score helps direct bed placement for patients with upper gastrointestinal bleeding

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000479 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000479

Author(s):

Drew B Schembre ◽

Robson E Ely ◽

Janice M Connolly ◽

Kunjali T Padhya ◽

Rohit Sharda ◽

...

Keyword(s):

Intensive Care ◽

High Risk ◽

Length Of Stay ◽

Gastrointestinal Bleeding ◽

Transfusion Requirement ◽

Upper Gastrointestinal Bleeding ◽

Low Risk ◽

Risk Patients ◽

Bleeding Score ◽

Upper Gastrointestinal

ObjectiveThe Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care.DesignWe reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator. Patients with a score ≤7 (low risk) were directed to an unmonitored bed (UMB), while those with a score of ≥8 (high risk) were considered for MB placement. Conformity with guidelines and subsequent transfers to MB were reviewed, along with transfusion requirement, rebleeding, length of stay, need for intervention and death.ResultsOver 34 months, 1037 patients received a GBS in the ER. 745 had an UGIB. 235 (32%) of these patients had a GBS ≤7. 29 (12%) low-risk patients were admitted to MBs. Four low-risk patients admitted to UMB required transfer to MB within the first 48 hours. Low-risk patients admitted to UMBs were no more likely to die, rebleed, need transfusion or require more endoscopic, radiographic or surgical procedures than those admitted to MBs. No low-risk patient died from GIB. Patients with GBS ≥8 were more likely to rebleed, require transfusion and interventions to control bleeding but not to die.ConclusionA semiautomated GBS calculator can be incorporated into an ER workflow. Patients with a GBS ≤7 are unlikely to need MB care for UGIB. Further studies are warranted to determine an ideal scoring system for MB admission.

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W1910 3-Year Retrospective Study and 1-Year Prospective Evaluation of a Clinical Guideline Recommending Early Discharge in Selected Patients with Low-Risk Non-Variceal Upper Gastrointestinal Bleeding (UGIB)

Gastroenterology ◽

10.1016/s0016-5085(08)63418-6 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-732

Author(s):

Maria Chaparro ◽

Felipe de la Morena ◽

Almudena Barbero ◽

L. Martin Martín ◽

Carlos Esteban ◽

...

Keyword(s):

Retrospective Study ◽

Gastrointestinal Bleeding ◽

Clinical Guideline ◽

Upper Gastrointestinal Bleeding ◽

Early Discharge ◽

Low Risk ◽

Prospective Evaluation ◽

Upper Gastrointestinal

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Acute upper gastrointestinal bleeding: identifying low risk patients

Gut ◽

10.1136/gutjnl-2012-302162 ◽

2012 ◽

Vol 61 (11) ◽

pp. 1641.1-1641

Author(s):

Richard F A Logan ◽

Sarah Hearnshaw ◽

Derek Lowe ◽

Simon P L Travis ◽

M Stephen Murphy ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Low Risk ◽

Acute Upper Gastrointestinal Bleeding ◽

Risk Patients ◽

Upper Gastrointestinal

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Triaging patients with upper gastrointestinal bleeding: the utility of Glasgow-Blatchford score

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195614 ◽

2019 ◽

Vol 8 (1) ◽

pp. 42

Author(s):

Namita Mohanty ◽

Arjun Nataraj Kannan

Keyword(s):

High Risk ◽

Blood Transfusion ◽

Gastrointestinal Bleeding ◽

Hospital Stay ◽

Upper Gastrointestinal Bleeding ◽

Positive Likelihood Ratio ◽

Low Risk ◽

P Value ◽

Duration Of Hospital Stay ◽

Upper Gastrointestinal

Background: Glasgow-Blatchford bleeding score (GBS), was developed to predict the need for hospital-based intervention (transfusion, endoscopic therapy or surgery) or death following upper gastrointestinal bleeding. Study evaluated the Glasgow Blatchford score’s (GBS) ability to identify high risk patients who needed blood transfusion in patients with UGI haemorrhage.Methods: A total of 270 cases admitted with upper gastrointestinal bleeding in the Medical ICU/Wards of MKCG Medical College were put on Blatchford scoring system and classified as those requiring (high risk = GBS >1) and not requiring blood transfusion (low risk) based on the score assigned on admission and a correlation between initial scoring and requirement of blood transfusion was done.Results: Units of blood transfusion required, the GBS and duration of hospital stay were significantly lower among the low risk group, all with p value <0.001. No blood transfusion was required in patients with GBS <3. There was significant correlation between GB score and requirement of blood transfusion (p <0.001) and duration of hospital stay (p <0.001). GBS had 100% sensitivity, negative predictive value and positive likelihood ratio, when a cut off of > 16 was used in predicting mortality.Conclusions: Patients presenting with Upper GI bleeding can be triaged in casualty with Glasgow Blatchford scoring. Patients with a low score of less than or equal to 3 can be safely discharged and reviewed on follow up thereby reducing admission, allowing more efficient use of hospital resources.

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The Acute Management of Nonvariceal Upper Gastrointestinal Bleeding

Ulcers ◽

10.1155/2012/361425 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Hisham AL Dhahab ◽

Alan Barkun

Keyword(s):

Emergency Department ◽

High Risk ◽

Gastrointestinal Bleeding ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Upper Gastrointestinal Bleeding ◽

Low Risk ◽

Acute Management ◽

Peptic Ulcers ◽

Upper Gastrointestinal

Background. The mortality from nonvariceal upper gastrointestinal bleeding is still around 5%, despite the increased use of proton-pump inhibitors and the advancement of endoscopic therapeutic modalities. Aim. To review the state-of-the-art management of acute non variceal upper gastrointestinal bleeding from the presentation to the emergency department, risk stratification, endoscopic hemostasis, and postendoscopic consolidation management to reduce the risk of recurrent bleeding from peptic ulcers. Methods. A PubMed search was performed using the following key words acute management, non variceal upper gastrointestinal bleeding, and bleeding peptic ulcers. Results. Risk stratifying patients with acute non variceal upper gastrointestinal bleeding allows the categorization into low risk versus high risk of rebleeding, subsequently safely discharging low risk patients early from the emergency department, while achieving adequate hemostasis in high-risk lesions followed by continuous proton-pump inhibitors for 72 hours. Dual endoscopic therapy still remains the recommended choice in controlling bleeding from peptic ulcers despite the emergence of new endoscopic modalities such as the hemostatic powder. Conclusion. The management of nonvariceal upper gastrointestinal bleeding involves adequate resuscitation, preendoscopic risk assessment, endoscopic hemostasis, and post endoscopic pharmacological and nonpharmacological treatment.

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