Glasgow- Blatchford score for GI bleed A patient with a score of 0 has a minimal risk of needing an intervention like transfusion, endoscopy or surgery. Introduction The Glasgow Blatchford score is a risk scoring tool used to predict the need to treat patients presenting with upper gastrointestinal bleeding. Assess if intervention is required for acute upper GI bleeding.
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Various risk scoring systems have been recently developed to predict clinical outcomes in patients with upper gastrointestinal bleeding UGIB.
Glasgow-Blatchford Bleeding Score (GBS) – MDCalc
Bleeding scores were assessed in terms of prediction of clinical outcomes in patients with UGIB. We followed glasgow-blatchcord 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. Eighteen patients were excluded from the study due to failure to follow-up.
Rebleeding and mortality rate were 9. We found the full RS system is better for 1-month mortality prediction while GBS system is better for prediction of other outcomes.
Then diagnostic endoscopy and if needed intervention must be performed. Various risk scoring systems have been recently developed to categorize patients with UGIB to high-risk and low-risk subgroups.
The two commonly used scoring systems include the full Rockall scoring RS system with preendoscopic and endoscopic components which predict mortality and the Glasgow-Blatchford scoring GBS system with basic clinical and laboratory data and it assesses low-risk GIB that does not require intervention. However, the use of these scoring systems may be confounded by some subjective parameters opening dcore interpretation. Diagnostic endoscopy glasyow-blatchford performed for all assigned patients on admission day or during the hospital stay.
Known-case of variceal bleeding patients and UGIB patients who received any treatment before admission were excluded. Demographic information, vital signs, physical exam findings, laboratory values, history of comorbid disease e. In addition, we followed the cases for records of rebleeding and 1-month mortality.
Pulse rate, systolic blood pressure, blood urea nitrogen, hemoglobin, presentation of melena, hepatic disease, and cardiac failure were recorded as variables of GBS system.
Independent sample t -test was also used to compare the mean values of continuous independent glasgwo-blatchford between two groups. A receiver operating characteristic ROC curve was used to identify the best cutoff point in order to maximize the sensitivity and specificity of the two scoring systems to predict clinical outcomes mortality, rebleeding, need for endoscopic glasgow-blatcchford, blood transfusion, and ICU admission of patients with UGIB.
P -values of 0. From patients, 18 patients were excluded due to failure in their 1-month follow-up. Thus the data of patients were analyzed Figure 1. Also, specificity and sensitivity of the two scoring systems in predicting clinical outcomes are shown in Table 4. The mean full RS was 3.
The most and the least frequent full RS scores were 4 The mean full RS score was significantly higher in nonsurvived patients in comparison scire survived ones 4. However, there is no significant difference between mean of GBS in nonsurvived and survived cases 7.
The mean GBS was significantly higher in the patients with rebleeding than other cases 8. Similarly, the mean GBS was significantly higher in the patients who were needing transfusion than the other cases 8. The present study attempted to assess and compare the value of two common applicable risk scoring systems including the full RS and the GBS systems to predict outcomes of patients with UGIB.
The outcomes of UGIB were categorized as 1-month mortality, rebleeding, need for blood transfusion, endoscopic intervention, and ICU admission.
Reviewing the literature achieved conflicting results as well as a variety of cutoff points for the two scoring system to predict clinical outcomes of UGIB.
Also, they showed high sensitivity of two systems for predicting transfusion need, against our study. None of them effectively excluded the need for endoscopic intervention.
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 The GBS appears more accurate at identifying patients with low risk of requiring intervention or death than full RS score and therefore may be more accurate for use in clinical practice, allowing outpatient management in low-risk patients.
However, there has been some debate as to the optimal GBS cutoff score for safely identifying this low-risk group.
Although, the full RS remains important for risk assessment following endoscopy particularly as it includes the endoscopic diagnosis, introducing a unique cutoff threshold for this system could not be achieved yet.
Our study had some limitations. At the first stage of the study, six gastroenterologists performed endoscopies. Thus, this procedure was not performed by only one gastroenterologist and this may have affected the full RS estimation.
However they were excluded from the study. In conclusion, the full RS system seems to be better in 1-month mortality prediction. Furthermore, GBS system is better in predicting rebleeding, the need for ICU admission, blood transfusion, and endoscopic intervention in emergency departments.
The cutoff points were considered for each system yielding high sensitivity but low specificity to predict these outcomes. More studies are needed to find an ultimate cutoff point for risk assessment of patients with UGIB. National Center for Biotechnology InformationU.
Journal List Clin Exp Gastroenterol v. Published online Oct Author information Copyright and License information Disclaimer. This work is published and licensed by Dove Medical Press Limited. The full terms of glasgow-blagchford license are available at https: By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from G,asgow-blatchford Medical Press Limited, provided the work is properly attributed.
This article has been cited by other articles in PMC. Abstract Background Various risk scoring systems have been recently developed to predict clinical outcomes in patients with upper gastrointestinal bleeding UGIB. Results Eighteen patients were excluded from the study due to failure to follow-up.
Conclusion We found the full RS system is better for 1-month mortality prediction while GBS system is better for prediction of other outcomes.
Results From patients, 18 patients were excluded due to failure in their 1-month follow-up. Open in a separate window. Table 1 Baseline demographic, clinical, and laboratory data of the cases. Table 2 Endoscopic findings and recent bleeding stigmata of cases. Table 3 Clinical outcomes of the patients.
Discussion The present study attempted to assess and compare the value of two common applicable risk scoring systems including the full RS and the GBS systems to predict outcomes of patients with UGIB.
Table 5 Clinical outcomes prediction of the present study and other similar studies. Limitations Our study had some limitations. Conclusion In conclusion, the full RS system seems to be better in 1-month mortality prediction. Footnotes Disclosure The authors report no conflicts of interest in this work.
Comparison of three different risk scoring systems in non-variceal upper gastrointestinal bleeding. Prospective validation of the Glasgow Blatchford scoring system glasgow-vlatchford patients with upper gastrointestinal bleeding in the emergency department. Factors effecting mortality and demographic properties of patients presenting to the Emergency Department of Akdeniz University Hospital with upper gastrointestinal bleeding.
Turk J Emerg Med. A prospective comparison of 3 scoring systems in upper gastrointestinal bleeding. Am J Emerg Med. Lim JK, Ahmed A. Endoscopic approach to the treatment of tlasgow-blatchford bleeding. Tech Vasc Interv Radiol. A risk score glasgow-blatchforr predict need for treatment for upper gastrointestinal haemorrhage. Clinical triage decision vs risk scores in predicting the need for endotherapy in upper gastrointestinal bleeding. Comparing the Blatchford and pre-endoscopic Rockall score in predicting the need for endoscopic therapy in patients with upper GI hemorrhage.
Risk scoring systems to predict need for clinical intervention for patients with non-variceal upper gastrointestinal tract bleeding. A modified Glasgow Blatchford score improves risk stratification in upper gastrointestinal bleed: Risk vlasgow-blatchford after acute upper gastrointestinal haemorrhage.
Validity of modified early warning, Glasgow Blatchford, and pre-endoscopic Rockall scores in predicting prognosis of patients presenting to emergency department with upper gastrointestinal bleeding. The performance of a modified Glasgow Blatchford score in predicting clinical interventions in patients with acute nonvariceal upper gastrointestinal bleeding: Comparison of scoring systems for nonvariceal upper gastrointestinal bleeding: Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department.
Eur J Gastroenterol Hepatol. Comparison of Rockall and Blatchford scores to assess outcome of patients with bleeding peptic ulcers after endoscopic therapy. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. External validation of the Glasgow-Blatchford bleeding score and the Rockall score in the US setting. Risk assessment scores for patients with upper gastrointestinal bleeding and their use in clinical practice.
Glasgow-Blatchford Bleeding Score