Comparative diagnostic utility of Rockall and Glasgow-Blatchford scores in non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis

Abstract

Introduction The Rockall score and Glasgow-Blatchford score (GBS) are two scoring systems validated in the evaluation of upper gastrointestinal bleeding (UGIB). However, no meta-analysis exists to summarize the current data and clarify the use of Rockall score and GBS focusing on non-variceal UGIB. We aimed to evaluate and compare the utility of the Rockall score and GBS in predicting clinical outcomes in non-variceal UGIB. Methods We conducted a systematic review and meta-analysis, searching the MEDLINE and EMBASE databases for all peer-reviewed articles using the terms including ‘Glasgow-Blatchford’, ‘Rockall’, and ‘gastrointestinal bleed’ from their inception to 22 March 2023. Outcomes included mortality, rebleeding, need for blood transfusion, and need for surgical intervention. Results Seven studies with 755 participants with non-variceal bleeding were included in the analysis. Pooled analysis demonstrated no difference in the area under the receiver operating characteristic (AUROC) between GBS and Rockall score to predict mortality [weighted mean difference (WMD) = 0.01, 95% CI: −0.06 to 0.08] or rebleeding (WMD = 0.04, 95% CI: −0.03 to 0.11). GBS had a higher AUROC to predict the outcomes compared to Rockall score for the needs for transfusion (WMD = 0.09, 95% CI: 0.01–0.16) and surgical intervention (WMD = 0.21, 95% CI: 0.14–0.29). Conclusion The GBS could be superior to the Rockall score in predicting the needs for transfusion and surgical intervention in non-variceal UGIB. However, both scores demonstrate low performance for predicting mortality or rebleeding.