Glasgow Blatchford Score and risk stratifications in acute upper gastrointestinal bleed: can we extend this to 2 for urgent outpatient management?

Abstract

Upper gastrointestinal (GI) bleeds are a common presentation to emergency departments in the UK. The Glasgow Blatchford score (GBS) predicts the outcome of patients at presentation. Current UK and European guidelines recommend outpatient management for a GBS of 0. In the current study, our aim was to assess whether extending the GBS allows for early discharge while maintaining patient safety. We also analysed whether pathologies could be missed by discharging patients too early. Data were retrospectively collected on patients admitted with symptoms of an upper GI bleed between 1 October 2013 and 10 June 2016. The GBS was calculated and gastroscopy reports were obtained for each patient. In total, 399 patients were identified, 63 of whom required therapy. The negative predictive value (NPV) for excluding the need for endoscopic intervention with a GBS score up to 1 was 100%. Extending the score to 2 and 3 reduced the NPV to 98.53% and 98.77%, respectively. The NPV of GBS in excluding any diagnosis at 0 was 43.55%. Two patients died as a result of GI bleeding, with a GBS score of 3. Therefore, we can conclude that, for non-variceal bleeds, the GBS can be extended to 2 for safe outpatient management, thereby reducing the number of bed days and pressure for urgent endoscopies.

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

“…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.…”

“…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.…”

“…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.…”

Diagnosis and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, Russian Society of Colorectal Surgeons and the Russian Endoscopic Society)

“…Комментарии ной воспалительной реакции, после чего могут быть применены хирургический и/или эндоскопический методы лечения [10,37,38,42,43]. Важно отметить, что при язвенном кровотечении риск смерти коморбидного пациента прямо коррелирует с количеством сопутствующих заболеваний [44].…”

Maintaining optimism in adversity: physicians leading innovation, education and responsible care delivery

“…3 These offer us evidence to inform the delivery of high-quality care whilst at the same Maintaining optimism in adversity: physicians leading innovation, education and responsible care delivery time relieving pressure on emergency departments and acute admissions units. While much of the pressure on the system in the winter crises has been blamed on sicker patients and naive centralist solutions moving care to the community, we should not discard all attempt to appropriately rationalise inpatient care, in scarce hospital beds, where possible.…”