Introduction Acute upper gastrointestinal bleeding is a medical emergency associated with a significant health burden and risk of mortality. A significant proportion of patients are admitted to hospital unnecessarily for endoscopy following presentation with acute upper gastrointestinal bleeding. The Blatchford score can be used to identify patients with low-risk gastrointestinal bleeds suitable for discharge and outpatient endoscopy. However, some debate remains regarding what level of Blatchford score can be considered low-risk. The aim of this study was to assess the need for intervention in patients presenting with upper gastrointestinal bleeding based upon the admission Blatchford score.
Methods All patients admitted with acute upper gastrointestinal bleeding to Sandwell and West Birmingham Hospitals NHS Trust from 1 January 2009 to 31 December 2009 were included in the study.
Results Overall, 470 patients with acute upper gastrointestinal bleeding were admitted during the study period. Of these 67.2% were male and 32.8% female. The mean age of patients was 64.0±18.8 years. The most common diagnosis was peptic ulcer disease, which was found in 34.5% of patients. A Blatchford score of 0 accounted for 6.0% of patients (n=28) and 14.7% (n=69) had a Blatchford score ≤2. Of the patients admitted with a Blatchford score ≤2 none required intervention (transfusion, endoscopic therapy or surgery) and there were no deaths. These patients were significantly younger than patients with a Blatchford score >2 (mean age 44.1±17.5 years for a Blatchford score ≤2 vs 67.4±18.8 years for a Blatchford score >2).
Conclusion Patients with acute upper gastrointestinal bleeding with a Blatchford score ≤2 did not require inpatient intervention and can be considered for early discharge from hospital with outpatient endoscopy. This strategy identified 14.7% of patients in our population that were unnecessarily admitted. Using a Blatchford score of ≤2 may help to significantly reduce hospital admissions.
Competing interests None Declared.
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