Introduction Upper gastrointestinal haemorrhage (UGIH) is a common medical emergency worldwide. The Glasgow Blatchford (GBS) and pre-endoscopy Rockall (PERS) scores are used to predict outcome and need for intervention. This retrospective study aims to determine their value in a mixed rural and urban population in New Zealand.
Methods GBS and PERS were determined for all adult patients admitted with UGIH to our teaching hospital between January 2007 and November 2011. Need for therapy (endoscopic, blood transfusion or surgery), 30-day mortality and 14-day re-bleed rate were recorded and the optimum scoring system for predicting low risk patients determined by logistic regression. The Lower South Regional Ethics Committee approved the study.
Results There were 424 admissions with UGIH: data was complete for 388 admissions to enable PERS and GBS calculation. Median age was 74.3 years, 55.1% were male and the majority were New Zealand European (85.8%). Commonest findings were oesophagitis, gastritis, duodenitis (43%), peptic ulcer (35.3%), hiatus hernia (16.8%), normal (11.9%), varices (4.8%) and malignancy (3.1%). 181 cases (46.6%) received an intervention, of which 75 (19.3%) had an endoscopic intervention, 147 (37.9%) a blood transfusion, 8 (2.1%) surgery and 7 (1.8%) an iron infusion. 30-day mortality was 4.6% (18 patients) and 14-day re-bleed rate was 6.0% (23 patients). GBS < 1 predicted low risk (no intervention, re-bleed or mortality), accounting for only 3.1% of all admissions (14 patients). 42 (10.8%) had a PERS of 0 but intervention was required in 15 (35.7%). A further 193 patients had outpatient gastroscopy for UGIH and 113 had inpatient bleeds during the study period.
Conclusion GBS (of < 1) is superior to PERS in identifying low risk patients who could be safely managed as outpatients following UGIH saving health resources. Despite having less patients with varices we had fewer low risk patients than British studies. Low risk patients may have been triaged to outpatient endoscopy by Primary Care.
Disclosure of Interest None Declared.
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