The management of low-risk primary upper gastrointestinal haemorrhage in the community

McLaughlin, Cara; Vine, Louisa; Chapman, Luke; Deering, Paula; Whittaker, Sam; Beckly, John; Fortun, Paul; Murray, Iain A.; Hussaini, S. Hyder; Michell, Nick; Stableforth, Bill; Thatcher, Peter; Hare, Nicola C.; Palmer, Joanne; Dalton, Harry R.

doi:10.1097/meg.0b013e32834febef

Cited by 18 publications

(7 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It was found to be safe as none of the patients received endoscopic therapy, blood transfusion or surgery for UGI bleeding. A GBS ≤ 2 supplemented with clinical criteria was used to select low-risk bleeders 14 .…”

Section: Discussionmentioning

confidence: 99%

Use of glasgow-blatchford bleeding score reduces hospital stay duration and costs for patients with low-risk upper GI bleeding

Girardin

Bertolini

Ditisheim

et al. 2014

EIO

View full text Add to dashboard Cite

Background and study aims: Upper gastrointestinal (UGI) bleeding is a frequent cause of hospitalization. Its severity may be assessed before endoscopy using the Glasgow-Blatchford Bleeding Score (GBS), a score validated to identify patients requiring clinical intervention. The aim of this study was to assess whether the GBS was effective for shortening hospital stay and reducing costs in patients with an UGI bleeding predicted at low risk of requiring clinical intervention. Patients and methods: Consecutive outpatients presenting with UGI bleeding at our hospital were prospectively included. In the observational study phase, UGI endoscopy was performed in all patients according to routine clinical practice. In the interventional study phase, patients with a GBS of 0 were discharged with an appointment for an outpatient UGI endoscopy. All patients had follow-up at 7 and 30 days. Need for clinical intervention was defined as performance of endoscopic hemostasis, blood transfusion or surgery. Results Two-hundred and eight patients were included, 104 in each study phase; complete follow-up was obtained in 201 patients. GBS varied from 0 to 18, with 15 (14 %) and 11 (11 %) patients having a GBS of 0 in the observational and interventional study phase, respectively. For patients with a GBS of 0, hospital stay was shorter (6 versus 19 h, P < 0.01), and costs were lower (845 EUR versus 1272 EUR, P = 0.002) in the interventional versus the observational study phase. For patients with a GBS > 0, hospital stay duration did not significantly differ between study phases (189 versus 207 h, P = 0.726). No adverse event was observed in the patients sent home with a GBS of 0 during the interventional study phase. Conclusions Implementing the GBS as a tool for triage of hospital outpatients who present with UGI bleeding allowed us to identify those who could safely be discharged for ambulatory management. Implementing this change in the hospital strategy significantly shortened hospital stay and decreased management costs.

show abstract

Section: Discussionmentioning

confidence: 99%

Use of glasgow-blatchford bleeding score reduces hospital stay duration and costs for patients with low-risk upper GI bleeding

Girardin

Bertolini

Ditisheim

et al. 2014

EIO

View full text Add to dashboard Cite

show abstract

“…Some studies have suggested that these scores could be used to identify patients at very low risk who could be managed as outpatients. [12][13][14] Studies have also suggested that these scores could identify patients at higher risk who might require urgent endoscopy or management in high dependency or intensive care units. 15 16 Several studies have compared scores in their ability to predict various outcomes.…”

Section: What This Study Addsmentioning

confidence: 99%

Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study

Stanley

Laine

Dalton

et al. 2017

BMJ

313

311

View full text Add to dashboard Cite

Objective To compare the predictive accuracy and clinical utility of five risk scoring systems in the assessment of patients with upper gastrointestinal bleeding.Design International multicentre prospective study.Setting Six large hospitals in Europe, North America, Asia, and Oceania.Participants 3012 consecutive patients presenting over 12 months with upper gastrointestinal bleeding.Main outcome measures Comparison of pre-endoscopy scores (admission Rockall, AIMS65, and Glasgow Blatchford) and post-endoscopy scores (full Rockall and PNED) for their ability to predict predefined clinical endpoints: a composite endpoint (transfusion, endoscopic treatment, interventional radiology, surgery, or 30 day mortality), endoscopic treatment, 30 day mortality, rebleeding, and length of hospital stay. Optimum score thresholds to identify low risk and high risk patients were determined.Results The Glasgow Blatchford score was best (area under the receiver operating characteristic curve (AUROC) 0.86) at predicting intervention or death compared with the full Rockall score (0.70), PNED score (0.69), admission Rockall score (0.66, and AIMS65 score (0.68) (all P<0.001). A Glasgow Blatchford score of ≤1 was the optimum threshold to predict survival without intervention (sensitivity 98.6%, specificity 34.6%). The Glasgow Blatchford score was better at predicting endoscopic treatment (AUROC 0.75) than the AIMS65 (0.62) and admission Rockall scores (0.61) (both P<0.001). A Glasgow Blatchford score of ≥7 was the optimum threshold to predict endoscopic treatment (sensitivity 80%, specificity 57%). The PNED (AUROC 0.77) and AIMS65 scores (0.77) were best at predicting mortality, with both superior to admission Rockall score (0.72) and Glasgow Blatchford score (0.64; P<0.001). Score thresholds of ≥4 for PNED, ≥2 for AIMS65, ≥4 for admission Rockall, and ≥5 for full Rockall were optimal at predicting death, with sensitivities of 65.8-78.6% and specificities of 65.0-65.3%. No score was helpful at predicting rebleeding or length of stay.Conclusions The Glasgow Blatchford score has high accuracy at predicting need for hospital based intervention or death. Scores of ≤1 appear the optimum threshold for directing patients to outpatient management. AUROCs of scores for the other endpoints are less than 0.80, therefore their clinical utility for these outcomes seems to be limited.Trial registration Current Controlled Trials ISRCTN16235737.

show abstract

“…In this cohort of patients the 28 d mortality rate was 0 [43] . The GBS has been shown to be as good as the Rockall score in predicting the need for any intervention, namely the need for therapeutic endoscopy [41,42,[44][45][46][47] .…”

Section: The Importance Of Outcomesmentioning

confidence: 99%

“…The authors concluded that using GBS ≤ 2 and age of less than 70 years to define lowrisk patients allows 10.5% of patients suffering from UGIB to be safely managed in the community. Over a 5-year period of managing such patients without hospital admission, McLaughlin et al [43] showed that any of them required endoscopic intervention, blood transfusion or surgery, and that the 28 d mortality was nil. A recent multicentre Danish study reported that a GBS cut-off value of ≤ 1 and an age modified low-risk version can be safely and effectively used to reduce unnecessary admissions for suspected UGIB [55] .…”

Section: The Importance Of Outcomesmentioning

confidence: 99%

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

Monteiro

Gonçalves

Magalhães

et al. 2016

WJGP

View full text Add to dashboard Cite

The management of low-risk primary upper gastrointestinal haemorrhage in the community

Abstract: Patients presenting with a primary upper gastrointestinal haemorrhage aged below 70 years with a Glasgow Blatchford Score of 2 or less are at a low risk, and can be safely managed in the community.

Cited by 18 publications

References 21 publications

Use of glasgow-blatchford bleeding score reduces hospital stay duration and costs for patients with low-risk upper GI bleeding

Use of glasgow-blatchford bleeding score reduces hospital stay duration and costs for patients with low-risk upper GI bleeding

Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study

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

Contact Info

Product

Resources

About