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Safe discharge of patients with low-risk upper gastrointestinal bleeding (UGIB): can use of Glasgow-Blatchford Bleeding Score (GBS) be extended?
  1. I R Le Jeune1,
  2. A Gordon1,
  3. D Farrugia1,
  4. R Manwani1,
  5. N Guha2,
  6. M W James *2
  1. 1Department of Acute medicine, Nottingham University Hospitals, Nottingham, UK
  2. 2Nottingham NIHR Biomedical Research Unit, Nottingham University Hospitals, Nottingham, UK

Abstract

Introduction Risk stratification of patients with suspected UGIB using either Glasgow-Blatchford Bleeding Score or pre-endoscopy Rockall score to facilitate early safe discharge (GBS = 0, pre-Rockall = 1) has been reported.1 2 This observational study compared score utility and considered the impact of extending the range of GBS or pre-Rockall scores permitting safe discharge.

Methods Consecutive adult patients presenting from September 2008-March 2009 with suspected UGIB to acute medicine and the emergency department had clinical history, vital signs, laboratory and endoscopy results prospectively recorded using electronic databases. GBS, pre-Rockall scores and a composite endpoint (blood transfusion, endoscopic therapy, interventional radiology and surgery or 30-day mortality) were calculated.

Results 388 patients with suspected UGIB were identified of which 92.3% were admitted (median (range) GBS = 5 (0–19) and Pre-Rockall = 2 (0–11)), representing 2.4% of 14,809 medical admissions. 7.7% were discharged (GBS = 0 (0–4) and Pre-Rockall = 0 (0–4)). 47.9% underwent endoscopy. 151 (38.9%) patients had the composite endpoint; of these, 77.5% received blood transfusion, 45.7% endoscopic treatment and 8.0% died within 30 days. AUROC (95% CI) for 30-day composite endpoint was 0.92 (0.89–0.94) using GBS and 0.75 (0.70–0.80) using pre-Rockall. Sensitivity, specificity, NPV and PPV for different GBS and pre-Rockall score thresholds are listed in table 1.

Table 1

OC-084 UGIB Risk Score

Conclusion GBS is superior to pre-Rockall in predicting patients with UGIB who can be safely discharged. Sensitivity analysis suggests that patients with GBS <3 could be considered for early discharge doubling the number of eligible patients (from 15.2% to 32.5%). This has important patient safety and financial implications.

  • risk stratification
  • upper gastrointestinal haemorrhage

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Footnotes

  • Competing interests None.

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