A prospective comparison of 3 scoring systems in upper gastrointestinal bleeding

Wang, Cheng-Hsien; Chen, Yuwei; Young, Yi‐Ho; Yang, Chia-Jung; Chen, I‐Chuan

doi:10.1016/j.ajem.2013.01.007

Cited by 49 publications

(61 citation statements)

References 24 publications

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“…The AUROC curve was 0.72. Wang et al 17 again had similar results when studying on Taiwanese patients. With GBS score greater than 0 as high risk, the sensitivity in detection was 100% with AUC curve >0.8 when predicting the need for blood transfusion, endoscopic and surgical intervention.…”

Section: Discussionsupporting

confidence: 66%

Comparison of Risk Stratification Scores for Patients Presenting with Symptoms of Upper Gastrointestinal Bleeding in the Emergency Department

Lau¹,

Wong²,

Lui³

et al. 2016

Hong Kong Journal of Emergency Medicine

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Objective: To compare four scoring systems to predict outcomes in patients with symptoms of upper gastrointestinal bleeding presenting to the emergency department. Method: A single centered prospective cohort study. All adult patients presenting to the emergency department of the studying centre with haematemsis or tarry stool or coffee ground vomiting or coffee ground aspirate from nasogastric tube were included from February 2012 to April 2012. The outcome variables include mortality, length of stay in hospital, blood product transfusion and interventions for bleeding control. The AIMS65 score, pre-endoscopic Rockall score, Glasgow Blatchford Score (GBS) and the modified Glasgow Blatchford Score (mGBS) were evaluated. Diagnostic characteristics were presented and areas under the receiver-operating-characteristic (AUROC) curve were compared. Results: A total of 129 patients were included in the study. 81 of them (62.8%) had upper endoscopy performed. The mortality rate was 3.1%. Initial haemoglobin level of <10 was an important factor in risk stratification. Validation of the 4 scoring systems showed GBS had highest sensitivities (98.3-100%) and negative predictive values (90-100%) for all outcome variables but could not achieve a good specificity and positive predictive values against the outcomes. Both GBS and modified GBS outperformed the other two scoring systems in the AUROC curves in predicting composite high-risk outcome, length of stay in hospital and blood transfusion. Conclusion: GBS appeared the best scoring system in the emergency department for screening purpose and to stratify those high risk patients for admission and low risk patients for out-patient management.

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Section: Discussionsupporting

confidence: 66%

Comparison of Risk Stratification Scores for Patients Presenting with Symptoms of Upper Gastrointestinal Bleeding in the Emergency Department

Lau¹,

Wong²,

Lui³

et al. 2016

Hong Kong Journal of Emergency Medicine

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“…In our institution a gastroenterologist is always on call, and endoscopy is performed in a mean time of 6-8 hours after admission. In the other reports, when available, endoscopy timing was within the first 12 hours at best, 22,27 which could determine, in patients under high PPI doses, somatostatin, or other treatments, the cessation of the bleeding with no endoscopic indication of therapy. The easy access to endoscopy could have made us find more active bleeders, which otherwise would have spontaneously stopped bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…This topic has only been partially analyzed in previous studies, which considered only 30 days mortality. 22,27 We considered such an extended period because upper GI bleeding can challenge the precarious clinical balance of frail patients, such as cirrhotic patients, patients with cardiovascular diseases in which changes in their usual treatments determined by their admission, or a worsening chronic condition that might have led to the bleeding, could be the cause of a delayed death. Indeed, cardiovascular causes accounted 30% of all the delayed deaths (Table 4), neoplasms 25% and GI bleeding only 27%.…”

Section: Discussionmentioning

confidence: 99%

Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality

Martínez-Cara

Jiménez-Rosales

Úbeda-Muñoz

et al. 2015

United European Gastroenterology Journal

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Objective: AIMS65 is a score designed to predict in-hospital mortality, length of stay, and costs of gastrointestinal bleeding. Our aims were to revalidate AIMS65 as predictor of inpatient mortality and to compare AIMS65's performance with that of Glasgow-Blatchford (GBS) and Rockall scores (RS) with regard to mortality, and the secondary outcomes of a composite endpoint of severity, transfusion requirements, rebleeding, delayed (6-month) mortality, and length of stay. Methods: The study included 309 patients. Clinical and biochemical data, transfusion requirements, endoscopic, surgical, or radiological treatments, and outcomes for 6 months after admission were collected. Clinical outcomes were in-hospital mortality, delayed mortality, rebleeding, composite endpoint, blood transfusions, and length of stay. Results: In receiver-operating characteristic curve analyses, AIMS65, GBS, and RS were similar when predicting inpatient mortality (0.76 vs. 0.78 vs. 0.78). Regarding endoscopic intervention, AIMS65 and GBS were identical (0.62 vs. 0.62). AIMS65 was useless when predicting rebleeding compared to GBS or RS (0.56 vs. 0.70 vs. 0.71). GBS was better at predicting the need for transfusions. No patient with AIMS65 ¼ 0, GBS 6, or RS 4 died. Considering the composite endpoint, an AIMS65 of 0 did not exclude high risk patients, but a GBS 1 or RS 2 did. The three scores were similar in predicting prolonged in-hospital stay. Delayed mortality was better predicted by AIMS65. Conclusion: AIMS65 is comparable to GBS and RS in essential endpoints such as inpatient mortality, the need for endoscopic intervention and length of stay. GBS is a better score predicting rebleeding and the need for transfusion, but AIMS65 shows a better performance predicting delayed mortality.

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“…Although some have argued for the broader use of decision support like the GBS in managing patients with UGIB [21], implementing its use in the ED to specifically identify the few low-risk patients who present does not seem to justify the costs and organizational effort required, especially with many competing needs to improve value of care. GBS is consistently superior to other tools in identifying lowrisk patients [4,5,22]. It also has been shown that higher GBS at admission is associated with recurrent bleeding after discharge [23].…”

Section: Discussionmentioning

confidence: 82%

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A prospective comparison of 3 scoring systems in upper gastrointestinal bleeding

Cited by 49 publications

References 24 publications

Comparison of Risk Stratification Scores for Patients Presenting with Symptoms of Upper Gastrointestinal Bleeding in the Emergency Department

Comparison of Risk Stratification Scores for Patients Presenting with Symptoms of Upper Gastrointestinal Bleeding in the Emergency Department

Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality

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