Clinical triage decision vs risk scores in predicting the need for endotherapy in upper gastrointestinal bleeding

Prospective validation of the Glasgow Blatchford scoring system in patients with upper gastrointestinal bleeding in the emergency department

“…Endoscopic results in the low-and high-risk groups of patients An ideal scoring system should have both a good sensitivity and high specificity. However, in the studies conducted, the sensitivity and specificity of the GBS system vary among high-risk patients with UGI system bleeding (10,12,13). In our study, the sensitivity and specificity were 100% and 1.41% for a cut-off value of GBS >0, 100% and 16.9% for a cut-off value of GBS >3, 96.63% and 36.62% for a cut-off value of GBS >5, and 86.52% and 69.01% for a cut-off value of GBS >8.…”

Practical Use of Blactchford Score

“…Previous studies have shown that scores of 5 or greater may an appropriate threshold for which patients may require intervention. 12,26 In our study, a sensitivity analysis revealed that the Blatchford Score of >5 would identify most patients with upper GI ulcers but had a specificity of only 32% which limits its application in clinical practice.…”

“…The Blatchford Score was developed to identify patients that required treatment to manage their bleeding 12,13 While this scoring system has been identified by some practice guidelines as a tool for identifying patients that may require intervention, 25 its usefulness in clinical practice may be limited. 13,26,27 In our study we attempted to evaluate whether a Blatchford Score of >5 would predict patients that would have an ulcer identified upon endoscopy. Previous studies have shown that scores of 5 or greater may an appropriate threshold for which patients may require intervention.…”

Upper gastrointestinal bleeding risk scores: Who, when and why?

“…Ideally, simple clinical scores could facilitate the identification of high-risk patients who could benefit from an early endoscopy with therapeutic intervention. Farooq et al [76] reported that the use of clinical Rockall and GBS was less accurate than a clinical triage decision in predicting the need for endoscopic therapy. In the study by Attar et al [67] , the GBS showed an equivalent sensitivity when compared to endoscopists (both 98%) in the detection of urgent upper endoscopy necessity.…”