Safe discharge of patients with low-risk upper gastrointestinal bleeding (UGIB): Can the use of Glasgow-Blatchford Bleeding Score be extended?

Introduction: Risk stratification of patients with suspected upper gastrointestinal bleeding (UGIB) using either Glasgow-Blatchford Bleeding Score (GBS) or preendoscopy Rockall score to facilitate early safe discharge (GBS=0, pre-Rockall=0) has been reported. This observational study compared score utility and considered the impact of extending the range of GBS or pre-Rockall scores permitting safe discharge. Methods: Consecutive adult patients presenting to acute medical admissions or the emergency department from September 2008-March 2009 with suspected UGIB had clinical history, vital signs, laboratory and endoscopy results prospectively recorded using electronic databases. GBS, pre-Rockall scores and a composite endpoint (blood transfusion, endoscopic therapy, interventional radiology, surgery or 30-day mortality) were calculated. Results: 388 patients with suspected UGIB were identified of which 92.3% were admitted (median (range) GBS=5 (0-19) and pre-Rockall=2 (0-11)) and 7.7% discharged (GBS=0 (0-4) and pre-Rockall=0 (0-4)). 186 (47.9%) underwent in-patient endoscopy. 151 (38.9%) were found to have the composite endpoint with 77.5% having transfusion, 45.7% endoscopic treatment and an 8.0% mortality within 30 days. AUROC (95% CI) for 30-day composite endpoint was 0.92 (0.89-0.94) using GBS and 0.75 (0.70-0.80) using pre-Rockall scores. Analysis using different GBS thresholds demonstrated that GBS=0, GBS ≤1 and GBS≤2 had superior utility in identifying freedom from an adverse clinical outcome at 30-days than pre-Rockall score 0. Conclusions: GBS is superior to pre-Rockall score in identifying patients with suspected UGIB who have a low likelihood of an adverse clinical outcome and can be considered for early discharge. Diagnostic performance at different thresholds suggests that patients with GBS≤2 could be considered for early discharge, doubling the number of eligible patients (15.2 to 32.5%). This has important patient safety and resource implications.

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108: External Validation of the Glasgow-Blatchford Bleeding Score and the Rockall Score In Emergency Department Patients With Upper Gastrointestinal Bleeding

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2010.06.151 ◽

2010 ◽

Vol 56 (3) ◽

pp. S36-S37

Author(s):

S. Chandra ◽

E.P. Hess ◽

D. Agarwal ◽

V. Montori ◽

L.M. Wong Kee Song ◽

...

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

External Validation ◽

Rockall Score ◽

Emergency Department Patients ◽

Bleeding Score ◽

Upper Gastrointestinal

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Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy

The Korean Journal of Internal Medicine ◽

10.3904/kjim.2014.099 ◽

2016 ◽

Vol 31 (3) ◽

pp. 470-478 ◽

Cited By ~ 7

Author(s):

Dong-Won Ahn ◽

Young Soo Park ◽

Sang Hyub Lee ◽

Cheol Min Shin ◽

Jin-Hyeok Hwang ◽

...

Keyword(s):

Clinical Outcome ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

After Hours ◽

Upper Gastrointestinal

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Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: a retrospective study

PeerJ ◽

10.7717/peerj.11656 ◽

2021 ◽

Vol 9 ◽

pp. e11656

Author(s):

Lan Chen ◽

Han Zheng ◽

Saibin Wang

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Area Under The Curve ◽

Decision Curve Analysis ◽

Acute Upper Gastrointestinal Bleeding ◽

Bleeding Score ◽

Selection Operator ◽

Upper Gastrointestinal ◽

D Dimer

Background Upper gastrointestinal bleeding is a common presentation in emergency departments and carries significant morbidity worldwide. It is paramount that treating physicians have access to tools that can effectively evaluate the patient risk, allowing quick and effective treatments to ultimately improve their prognosis. This study aims to establish a mortality risk assessment model for patients with acute upper gastrointestinal bleeding at an emergency department. Methods A total of 991 patients presenting with acute upper gastrointestinal bleeding between July 2016 and June 2019 were enrolled in this retrospective single-center cohort study. Patient demographics, parameters assessed at admission, laboratory test, and clinical interventions were extracted. We used the least absolute shrinkage and selection operator regression to identify predictors for establishing a nomogram for death in the emergency department or within 24 h after leaving the emergency department and a corresponding nomogram. The area under the curve of the model was calculated. A bootstrap resampling method was used to internal validation, and decision curve analysis was applied for evaluate the clinical utility of the model. We also compared our predictive model with other prognostic models, such as AIMS65, Glasgow-Blatchford bleeding score, modified Glasgow-Blatchford bleeding score, and Pre-Endoscopic Rockall Score. Results Among 991 patients, 41 (4.14%) died in the emergency department or within 24 h after leaving the emergency department. Five non-zero coefficient variables (transfusion of plasma, D-dimer, albumin, potassium, age) were filtered by the least absolute shrinkage and selection operator regression analysis and used to establish a predictive model. The area under the curve for the model was 0.847 (95% confidence interval [0.794–0.900]), which is higher than that of previous models for mortality of patients with acute upper gastrointestinal bleeding. The decision curve analysis indicated the clinical usefulness of the model. Conclusions The nomogram based on transfusion of plasma, D-dimer, albumin, potassium, and age effectively assessed the prognosis of patients with acute upper gastrointestinal bleeding presenting at the emergency department.

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Complete Rockall score in predicting outcomes of elderly patients with acute non-variceal upper gastrointestinal bleeding: A tertiary care study

Assam Journal of Internal Medicine ◽

10.4103/ajoim.ajoim_13_21 ◽

2021 ◽

Vol 11 (2) ◽

pp. 37

Author(s):

SubhaLakshmi Das ◽

Ankur Bhattacharyya

Keyword(s):

Elderly Patients ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Tertiary Care ◽

Rockall Score ◽

Upper Gastrointestinal ◽

Care Study

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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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