Performance of Three Scoring Systems in Predicting Massive Transfusion in Patients with Unstable Upper Gastrointestinal Hemorrhage

PURPOSE: After trauma and surgery, upper gastrointestinal bleeding (UGIB) is the most common condition that can require massive transfusion (MT). The present study aimed to analyze and compare the prognostic performance of the Glasgow-Blatchford (GB), pre-endoscopy Rockall (PER), and modified early warning (MEW) scores for predicting MT in patients with unstable UGIB. MATERIALS AND METHODS: This retrospective observational study included patients with UGIB from March 2016 to February 2018. Receiver operating characteristics analysis was performed to examine the prognostic performance of the GB, PER, and MEW scoring systems. Logistic regression analysis was used to identify independent risk factors for MT, after adjusting for relevant covariates. The primary outcome was MT. RESULTS: Of the 484 included patients with unstable UGIB, 19 (3.9%) received an MT. The areas under the curves (AUCs) of the GB, PER, and MEW scores for MT were 0.577 [95% confidence interval (CI), 0.531–0.621], 0.570 (95% CI, 0.525–0.615), and 0.767 (95% CI, 0.727–0.804), respectively. The AUC of the MEW score was significantly different from those of the GB and PER scores. In multivariate analysis, MEW score was independently associated with MT in patients with unstable UGIB (odds ratio, 1.495; 95% CI, 1.100–2.033; p=0.010). CONCLUSION: In unstable UGIB patients, MEW score had the best prognostic performance for MT among three scoring systems.

Necessity of Epinephrine in Pre-Hospital Stage: In the Early Management of Anaphylaxis Following a Bee Sting

PURPOSE: Anaphylaxis is a serious allergic reaction of rapid onset that may lead to death. The primary treatment for anaphylaxis is epinephrine. However, use of epinephrine in pre-hospital stage is unavailable, because epinephrine is not permitted to be equipped in the 119 rescue ambulance and use of epinephrine by emergency medical technicians (EMT) is not authorized by law in Korea. The aim of this study is to identify the necessity of using epinephrine in prehospital stage from the perspective of early management of anaphylaxis following a bee sting. METHODS: Patients suffering from a bee sting who used the 119 rescue in Jeollanamdo between 2008 to 2011 were included. Age, sex, month of injury, time factors, distance factors, presence of cardiac arrest, AVPU triage by EMT, presenting symptoms, and signs were extracted. The severity of bee sting injury was divided into mild, moderate, and severe according to the presenting symptoms and signs. RESULTS: A total of 1,647 patients were included: 917 (55.7%) patients were classified as mild; 480(29.1%) patients were classified as moderate; and 250(15.2%) patients were classified as severe. The median of total transport time and distance was 32 minutes and 21.3 kilometers, respectively. Nine patients collapsed at the scene. Bee sting injuries occurred primarily from June to October. CONCLUSION: The incidence of anaphylaxis following a bee sting was not low. The transport time was relatively long, since bee stings occur primarily in rural areas. Therefore, for early management of anaphylaxis, equipment of epinephrine in the 119 rescue ambulance and use of epinephrine by EMTs should be considered.