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Background : Upper Gastrointestinal Bleeding is a common emergency with varying degrees of severity. Haemorrhage is managed by Therapeutic Endoscopy, Radiological Intervention or Surgery and Blood Transfusion which are available only in Tertiary Care Centre. So, when patient presents in primary healthcare setting, it is important to recognize the patients who need this treatment. Glasgow-Blatchford Score is a score which is used for this purpose. The purpose of this research was to validate its reliability in identifying such high-risk patients. Materials and Methods : This study was prospective and observational, conducted in Medical College and Hospital, from December, 2017 to May, 2019. All adult patients presenting to Emergency Department with sudden onset Upper Gastrointestinal Bleeding were included. Glasgow-Blatchford Score was computed. Patients were followed up till their discharge (or death) from the hospital. The therapeutic management needed and its relationship with the score and treatment modalities were noted. Area under Receiver Operating Characteristic (ROC) Curve was calculated. Results : Total 100 patients were included in study. 85% were male and 15% were female. Glasgow-Blatchford Score was found as a good predictor in discriminating patients. Patients with score 14. Interventional radiology or surgery was never used. The area under ROC Curve was 0.738 suggesting fair reliability. Conclusion : Glasgow-Blatchford Score is good predicting tool in cases of Upper Gastrointestinal bleeding and patients with score >7 should be transferred to speciality centres
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ABSTRACT BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.
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ABSTRACT BACKGROUND: Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce. OBJECTIVE: This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome. METHODS: In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared. RESULTS: The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725). CONCLUSION: Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.
RESUMO CONTEXTO: Tradicionalmente, a doença úlcera péptica era a causa mais comum de sangramento digestivo alto, mas com a mudança da epidemiologia, outras etiologias do sangramento do trato digestivo alto estão emergindo. Muitas pontuações têm sido descritas para prever resultados e a necessidade de intervenção na hemorragia gastrointestinal superior, mas a comparação prospectiva entre elas é escassa. OBJETIVO: Este estudo foi planeado para determinar o padrão etiológico de pacientes com hemorragia digestiva alta e comparar os escores de Glasgow Blatchford, o Rockall pré-endoscopia, o AIMS65 e o Early Warning modificado (MEWS) como preditores do resultado. MÉTODOS: Neste estudo prospetivo de coorte, 268 pacientes com sangramento digestivo alto foram acompanhados durante 8 semanas. Os escores Glasgow Blatchford, Rockall pré-endoscopia, AIMS65 e MEWS foram calculados para cada paciente, e a área sob a curva (AUC-ROC) para cada pontuação foi comparada. RESULTADOS: A etiologia mais comum para a hemorragia gastrointestinal alta foi varizes gastroesofágicas 150 (63,55%), seguida de úlcera péptica 29 (12,28%) e de doença erosiva de mucosa 27 (11,44%). No total, 38 (15,26%) doentes voltaram a sangrar e 71 (28,5%) doentes morreram. No total, 126 (47%) doentes necessitaram de transfusão de componentes sanguíneos, 25 (9,3%) necessitaram de ventilação mecânica e 2 (0,74%) destes doentes necessitaram de intervenção cirúrgica. O escore de Glasgow Blatchford foi o melhor na previsão da necessidade de transfusão (corte - 10, AUC-ROC =0,678). Enquanto o AIMS65 com uma pontuação de ≥2 foi o melhor na previsão de ressangramento (AUC-ROC =0,626) e mortalidade (AUC-ROC =0,725). CONCLUSÃO: O sangramento gastrointestinal alto mais comum é de origem varicosa em centro de referência terciária. O AIMS65 é o melhor escore simples, com uma pontuação de ≥2 para prever o ressangramento e a mortalidade.
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Introduction: The GBS enables assessment of risk based on clinical variables alone without the use of endoscopic findings. Its purpose is to aid in identification of patients requiring intervention, such as blood transfusion, or endoscopic or surgical intervention to control UGI haemorrhage. Study objective was to correlate the requirement of blood transfusion in patients presenting with upper gastrointestinal bleeding and Blatchford scoring system.To analyse and correlate the score with prediction of rebleeding, duration of hospital stay. Material and Methods: A Cross sectional quantitative study was conducted in Medical ICU/Wards of Pushpagiri medical college. From (January 2016 to June 2017). All Patients admitted with upper gastrointestinal bleeding during this period was selected as sample size. A detailed history was taken, and a thorough clinical examination was done, complemented by relevant investigation as required for the study. Unpaired t-test,Chi square test and Correlation were used as Test of significance. P-value <0.05 is considered statistically significant using Epi-info 7 software. Results: Majority of patients were in the age group of 41 to 50 years (28.6%). 72.6% were males and the remaining females. 54.8% of patients did not require blood transfusion at all, 20.2% was transfused 1 unit of packed red cells and only 1.2% with 4 units. Only 3.6% patients who presented with upper GI bleed had a rebleeding which further tells the need of blood transfusion.majority of the patients had a mean hospital stay of 5 – 8 days around 48%. There was significant correlation between Blatchford score on admission and requirement of blood transfusion (p value 0.000) and duration of hospital stay (p value 0.008). Conclusion: There was a significant correlation between Blatchford scoring on admission and requirement of blood transfusion. There was also a significant correlation between initial Blatchford scoring and duration of hospital stay and outcome
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Introduction: The Glasgow-Blatchford bleeding score (GBS) was developed in 2000 to predict the need for hospital-based intervention (transfusion, endoscopic therapy or surgery) or death following UGIB. Objective: To compare the requirement of blood transfusion in patients presenting with upper gastrointestinal bleeding using Blatchford scoring system. To determine the association of GB score with the outcomes of UGI. Materials and methods: A Cross-sectional observational study was conducted in Medical ICU/Wards of Pushpagiri Medical College from January 2016 to June 2017. All Patients admitted with upper gastrointestinal bleeding during this period was selected as sample size. A detailed history was taken, and a thorough clinical examination was done, complemented by relevant investigation as required for the study. Unpaired t-test and Chi square test were used as Test of significance. P-value <0.05 was considered statistically significant using Epi-info 7 software. Results: Majority of patients were in the age group of 41 to 50 years (28.6 %). 72.6% were males and the remaining females. 54.8% of patients did not require blood transfusion at all, 20.2% was transfused 1 unit of packed red cells and only 1.2% with 4 units. 59.5% of patients who presented Abraham Varghese V, Prasanna Hegde. A Cross Sectional Study on Requirement of Blood Transfusion in Upper Gastrointestinal Bleeding using Blatchford Bleeding Score. IAIM, 2019; 6(5): 149-153. Page 150 with Upper GI bleed had oesophageal/fundal varices and the rest (40.5%) had a non-variceal etiology. The minimum Blatchford scoring on admission was 1 and the maximum score was 16. Significant association between initial Blatchford scoring and outcome (p value 0.001) was noted. Conclusion: Patients should be triaged in casualty with Blatchford scoring. High score helps in predicting the requirement of blood transfusion and outcome of patients so that they can be managed judiciously.
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Objective To compare Glasgow-Blatchford score (GBS) with full Rockall score system (full RS) in predicting clinical outcomes of upper gastrointestinal bleeding(UGIB).Methods Four hundred hospitalized UGIB patients were enrolled in this study in Baoji Central Hospital from March 2014 to June 2016. Patients were scored by full RS and GBS,respectively.The receiver operating characteristic(ROC)curve analysis was used to compare the predictive values of the two score systems for mortality,re-bleeding,transfusion,ICU admission and endoscopic intervention. Results Thirty-eight cases were lost in follow-up. The one-month mortality rate, re-bleeding rate, blood transfusion rate, ICU admission rate and endoscopic intervention rate of 362 patients were 11.6%, 9.4%, 17.7%, 13.3% and 16.0%, respectively. GBS showed better predictive values in ICU admission (AUC=0.731, P=0.009), re-bleeding (AUC=0.707, P=0.019), blood transfusion (AUC=0.704, P=0.021) and endoscopic intervention (AUC=0.742, P=0.006). Full RS showed better predictive values in one-month mortality (AUC=0.681, P=0.040). There was significant difference in predicting value of clinical outcomes of UGIB by ROC curve between GBS and full-RS systems (P<0.05). Conclusion The GBS system is more suitable for predicting clinical outcomes of ICU admission, re-bleeding, blood transfusion and endoscopic intervention in patients of UGIB.The full-RS system is more suitable for predicting one-month mortality of UGIB patients.
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BACKGROUND/AIMS: The AIMS65 score has not been sufficiently validated in Korea. The objective of this study was to compare the AIMS65 and other scoring systems for the prediction of various clinical outcomes in Korean patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB). METHODS: The AIMS65 score, clinical and full Rockall scores (cRS and fRS) and Glasgow-Blatchford (GBS) score were calculated in patients with NVUGIB in a single center retrospectively. The performance of these scores for predicting mortality, rebleeding, transfusion requirement, and endoscopic intervention was assessed by calculating the area under the receiver-operating characteristic curve. RESULTS: Of the 523 patients, 3.4% died within 30 days, 2.5% experienced rebleeding, 40.0% required endoscopic intervention, and 75.7% needed transfusion. The AIMS65 score was useful for predicting the 30-day mortality, the need for endoscopic intervention and for transfusion. The fRS was superior to the AIMS65, GBS, and cRS for predicting endoscopic intervention and the GBS was superior to the AIMS65, fRS, and cRS for predicting the transfusion requirement. CONCLUSIONS: The AIMS65 score was useful for predicting the 30-day mortality, transfusion requirement, and endoscopic intervention in Korean patients with acute NVUGIB. However, it was inferior to the GBS and fRS for predicting the transfusion requirement and endoscopic intervention, respectively.
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Humans , Hemorrhage , Korea , Mortality , Retrospective StudiesABSTRACT
PURPOSE: Upper gastrointestinal bleeding (UGIB) is a common medical emergency condition in the emergency department (ED). Patients with UGIB show a wide range of clinical severity, from mild bleeding to death. The objective of this study was to evaluate methods for risk stratification of active UGIB in the ED. METHODS: We retrospectively reviewed patients with UGIB who were admitted to the ED of a tertiary care, university-affiliated hospital center from January 2011 to December 2011. Our study subjects were patients over 20 years old who complained of symptoms and signs of gastrointestinal tract bleeding and underwent endoscopic gastroduodenoscopy (EGD) evaluation. However, patients diagnosed with variceal gastrointestinal bleeding, disseminated malignancy, coagulopathy, and lower gastrointestinal bleeding and patients who did not undergo EGD within 6 hours were excluded. The Blatchford score and the clinical Rockall score were calculated for the enrolled patients. In cases where the value of each score was greater than 0, the scores were considered high risk. Active UGIB was defined as a symptom of patients who underwent emergency endoscopic intervention such as ligation or sclerotherapy. We compared the proportions of patients identified as high risk using chi tests. The areas under the receiver operating characteristic (AUROC) curve for detection of patients requiring emergency endoscopic intervention were calculated for both the Blatchford score and the clinical Rockall score. RESULTS: The numbers of patients with high risk according to the Blatchford score and the clinical Rockall were 220 (93.6%) and 192 (81.7%) of 235 patients, respectively. The number of patients with active UGIB was 96 (40.9%) of 235 patients. The sensitivity and specificity of risk stratification based on the Blatchford score was 100% (96/96) and 10.8% (15/139) (p=0.001), respectively, while those based on the clinical Rockall score were 80.2% (77/96) and 17.3% (24/139) (p>0.05). The AUROC curves of the Blatchford score and the clinical Rockall score were 0.617 (95% CI; 0.546-0.688) and 0.495 (95% CI; 0.420-0.571), respectively. CONCLUSION: The Blatchford score could be more useful as a risk stratification tool than the clinical Rockall score for active UGIB patients in the ED. The Blatchford score would be preferable as a clinical tool that can discriminate patients who need emergency endoscopic intervention for control of UGIB.
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Humans , Emergencies , Emergency Service, Hospital , Endoscopy , Gastrointestinal Hemorrhage , Gastrointestinal Tract , Hemorrhage , Ligation , Retrospective Studies , ROC Curve , Sclerotherapy , Sensitivity and Specificity , Tertiary HealthcareABSTRACT
PURPOSE: The Glasgow Blatchford Score (GBS) and the Rockall score are validated risk tools for predicting adverse outcomes in patients with upper gastrointestinal bleeding (UGIB). In this study, we attempted to validate these risk assessment tools in patients with active cancer who visited an emergency department (ED) with UGIB. METHODS: We retrospectively reviewed electronic medical records of patients with active cancer presented to Asan Medical Center ED from January 2009 to December 2011. The primary outcomes required therapeutic interventions (transfusion, endoscopic/surgical/radiologic interventions), and there was a recurrence of bleeding or mortality within 30 days. RESULTS: Of the 225 patients, 197(87.6%) needed interventions. The area under the receiver-operator curves showed that the GBS [0.86; 95% Confidence Interval (CI), 0.77-0.95] surpassed the clinical Rockall (0.67; 95% CI, 0.55-0.79) and full Rockall scores (0.72; 95% CI, 0.61-0.83) in predicting clinical interventions. Regarding a score of 2 or less as negative, the GBS showed a sensitivity of 0.99 and a specificity of 0.54. When patients were divided according to their source of bleeding, the sensitivity and specificity did not change. CONCLUSION: The GBS outperformed clinical and full Rockall scores in predicting the intervention in patients with active cancer. The source of bleeding was not an important factor in the score's performance. The GBS also showed very good sensitivity; however, its specificity is suboptimal and limits its role as a sole indicator for decisions in cancer patients with UGIB.