Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department

Aquarius, Michèl; Smeets, Fabienne G.; Konijn, Helena W.; Stassen, Patricia M.; Keulen, Eric T.P.; Deursen, C.T. van; Masclee, Ad; Keulemans, Yolande C.A.

doi:10.1097/meg.0000000000000402

Cited by 22 publications

(17 citation statements)

References 23 publications

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“…In terms of predicting rebleeding, the full RS system was superior to the GBS system, which is not the same as our study. As shown by Aquarius et al, the GBS system had the optimal combination of sensitivity (99.4%) and specificity (42.4%) at a cutoff value of up to 2 as the best determinative point for mortality prediction 15. Lee et al found that the full RS system was more accurate than the GBS system for predicting mortality, same as our study.…”

Section: Discussionsupporting

confidence: 85%

Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding

Mokhtare¹,

Bozorgi²,

Agah³

et al. 2016

CEG

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BackgroundVarious risk scoring systems have been recently developed to predict clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). The two commonly used scoring systems include full Rockall score (RS) and the Glasgow-Blatchford score (GBS). Bleeding scores were assessed in terms of prediction of clinical outcomes in patients with UGIB.Patients and methodsTwo hundred patients (age >18 years) with obvious symptoms of UGIB in the emergency department of Rasoul Akram Hospital were enrolled. Full RS and GBS were calculated. We followed the patients for records of rebleeding and 1-month mortality. A receiver operating characteristic curve by using areas under the curve (AUCs) was used to statistically identify the best cutoff point.ResultsEighteen patients were excluded from the study due to failure to follow-up. Rebleeding and mortality rate were 9.34% (n=17) and 11.53% (n=21), respectively. Regarding 1-month mortality, full RS was better than GBS (AUC, 0.648 versus 0.582; P=0.021). GBS was more accurate in terms of detecting transfusion need (AUC, 0.757 versus 0.528; P=0.001), rebleeding rate (AUC, 0.722 versus 0.520; P=0.002), intensive care unit admission rate (AUC, 0.648 versus 0.582; P=0.021), and endoscopic intervention rate (AUC, 0.771 versus 0.650; P<0.001).ConclusionWe found the full RS system is better for 1-month mortality prediction while GBS system is better for prediction of other outcomes.

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Section: Discussionsupporting

confidence: 85%

Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding

Mokhtare¹,

Bozorgi²,

Agah³

et al. 2016

CEG

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“…The authors concluded this low-risk subgroup were eligible for outpatient management, which might reduce hospital admissions and healthcare costs. 20 Further to this, one study indicated that patients with a GBS of 2 or less could be suitable for outpatient management doubling the number of eligible patients for early discharge. 16 From our results, two patients with a GBS of 3 died within 30 days of presentation.…”

Section: Discussionmentioning

confidence: 96%

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

et al. 2018

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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.

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“…6 Patients with a GBS of 2 or less are considered to have a low risk and are eligible for outpatient management. 7 Although the GBS cut-off value for high-risk patients still is ambiguous, patients with a GBS greater than 7 were shown to have increased risks of significant bleeding and mortality. 8 In many studies, high-risk patients showed an extremely high mortality rate of up to 25%.…”

mentioning

confidence: 99%

Outcomes and Role of Urgent Endoscopy in High-Risk Patients With Acute Nonvariceal Gastrointestinal Bleeding

Cho

Lee

Kim

et al. 2018

Clinical Gastroenterology and Hepatology

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Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department

Cited by 22 publications

References 23 publications

Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding

Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding

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

Outcomes and Role of Urgent Endoscopy in High-Risk Patients With Acute Nonvariceal Gastrointestinal Bleeding

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