Discharge of patients with an acute upper gastrointestinal bleed from the emergency department using an extended Glasgow-Blatchford Score

Banister, Thomas; Spiking, Josesph; Ayaru, Lakshmana

doi:10.1136/bmjgast-2018-000225

Cited by 14 publications

(26 citation statements)

References 34 publications

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“…In our study, in predicting need for blood transfusion, all scores performed well, but modified AIMS65 had slightly better accuracy; however, in predicting need for endoscopic intervention, only modified AIMS65, GBS and FRS had meaningful accuracy (p < 0.05). Although, outperformance of GBS in assessment of need for clinical intervention has been shown in other studies [20,[24][25][26], we found modified AIMS65 as a good fit alternative.…”

Section: Discussioncontrasting

confidence: 57%

“…Increasing the cutoff point acts as two edged sword. Higher cut off can identify more low risk patient leading to even more reduction in cost; while, in the meantime, the risk of adverse outcome increases [2,14,24,38]. In our study no patients died within GBS ≤ 2 and 3.39% had adverse outcome of 30-day rebleeding and need for endoscopic therapy while in AIMS65 = 0, 14.28% had adverse outcome and 1.29 % (3 patients) had mortality.…”

Section: Discussionmentioning

confidence: 47%

“…Conspicuously, classifying patients in to high risk and low risk group is crucial and yet a challenging step for management of UGIB. One of the barriers is finding an optimal cut off point for risk scores [24]. In our study we used the cutoff point that maximized the sum of the sensitivity and the specificity in mortality to stratify patients in to high risk and low risk group.…”

Section: Discussionmentioning

confidence: 99%

“…This cut off was increased to ≤1 in the prospective study conducted by Stanley, J. et al and except one, none of the patients required intervention nor transfusion [27]. This cut off has also been extended safely to ≤2 in some studies [2,24,25]. Increasing the cutoff point acts as two edged sword.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, since GBS is the preferred scoring system in predicting the need for clinical intervention [20,[24][25][26], our third objective was to assess whether addition of albumin to this system can increase its predictive accuracy in predicting mortality or not.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding; modifying Glasgow-Blatchford with albumin

Shafaghi¹,

Gharibpoor

Mahdipour

et al. 2019

Romanian Journal of Internal Medicine

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Introduction. Management of upper gastrointestinal bleeding (UGIB) is of great importance. In this way, we aimed to evaluate the performance of three well known scoring systems of AIMS65, Glasgow-Blatchford Score (GBS) and Full Rockall Score (FRS) in predicting adverse outcomes in patients with UGIB as well as their ability in identifying low risk patients for outpatient management. We also aimed to assess whether changing albumin cutoff in AIMS65 and addition of albumin to GBS add predictive value to these scores. Methods. This was a retrospective study on adult patients who were admitted to Razi hospital (Rasht, Iran) with diagnosis of upper gastrointestinal bleeding between March 21, 2013 and March 21, 2017. Patients who didn’t undergo endoscopy or had incomplete medical data were excluded. Initially, we calculated three score systems of AIMS65, GBS and FRS for each patient by using initial Vital signs and lab data. Secondary, we modified AIMS65 and GBS by changing albumin threshold from <3.5 to <3.0 in AIMS65 and addition of albumin to GBS, respectively. Primary outcomes were defined as in hospital mortality, 30-day rebleeding, need for blood transfusion and endoscopic therapy. Secondary outcome was defined as composition of primary outcomes excluding need for blood transfusion. We used AUROC to assess predictive accuracy of risk scores in primary and secondary outcomes. For albumin-GBS model, the AUROC was only calculated for predicting mortality and secondary outcome. The negative predictive value for AIMS65, GBS and modified AIMS65 was then calculated. Result. Of 563 patients, 3% died in hospital, 69.4% needed blood transfusion, 13.1% needed endoscopic therapy and 3% had 30-day rebleeding. The leading cause of UGIB was erosive disease. In predicting composite of adverse outcomes all scores had statistically significant accuracy with highest AUROC for albumin-GBS. However, in predicting in hospital mortality, only albumin-GBS, modified AIMS65 and AIMS65 had acceptable accuracy. Interestingly, albumin, alone, had higher predictive accuracy than other original risk scores. None of the four scores could predict 30-day rebleeding accurately; on the contrary, their accuracy in predicting need for blood transfusion was high enough. The negative predictive value for GBS was 96.6% in score of ≤2 and 85.7% and 90.2% in score of zero in AIMS65 and modified AIMS65, respectively. Conclusion. Neither of risk scores was highly accurate as a prognostic factor in our population; however, modified AIMS65 and albumin-GBS may be optimal choice in evaluating risk of mortality and general assessment. In identifying patient for safe discharge, GBS ≤ 2 seemed to be advisable choice.

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Section: Discussioncontrasting

confidence: 57%