Introduction Upper GI bleeding (UGIB) is a common presentation to the emergency department.1 Studies assessing the effectiveness of the Glasgow Blatchford Score (GBS) as a risk stratification tool are well documented in the literature. National Institute of Clinical Excellence (NICE) recommends that all patients admitted with suspected UGIB require a GBS score. This study evaluated the effectiveness of the GBS in predicting the need for endoscopic therapy. It also evaluated whether there was any correlation between the GBS with re-bleeding rates and 30 day mortality.
Methods Electronic UGIB requests between January to July 2015 were evaluated retrospectively. Patients who were deemed medically fit for the procedure and underwent a gastroscopy as an in-patient were included in this study. Patients deemed medically unfit for a gastroscopy or were discharged prior to in-patient gastroscopy being performed were excluded from the study. The OGD reports were subsequently retrieved from electronic endoscopy reporting system “Unisoft” and the GBS was retrieved from the electronic request system. The re-bleeding rate and 30 day mortality were evaluated from the review of the electronic patient records. The data collected was entered onto Microsoft Excel 2010 spreadsheet and a chi-square test was applied.
Results There were a total of 182 requests for urgent in-patient gastroscopy. 25 patients were excluded from the study - 3 were medically unfit for OGD on arrival, 3 unable to intubate, 1 request was later deemed not required, 1 was changed to outpatients and 17 no OGD reports could be retrieved from Unisoft. The remaining 157 underwent urgent in-patient gastroscopy. Age distribution ranged from 22 to 103 with mean age of 63. 90 patients were male (57%) and 67 were female (43%). Of the 157 patients, 48 (31%) required endoscopic intervention compared to 109 (69%) who did not. Of the 48 patients that required endoscopic intervention, 8 scored GBS < 6 and 40 had GBS ≥ 6. The correlation between GBS and the need for endoscopic intervention was found to be statistically significant (p < 0.001). Of the 157 patients, the re-bleeding rate was 1.8% (n = 3) during the same hospital admission and the 30 day mortality rate of 5.7% (n = 9). From the re-bleeding group, the mortality rate was 33% (n = 1). No statistical significance between GBS with re-bleeding rates (p = 0.17) and mortality (p = 0.33) was found.
Conclusion This study identified that a GBS ≥ 6 significantly correlates with the likelihood of requiring endoscopic intervention as compared to a GBS < 6. However, the GBS did not correlate with in-patient re-bleeding rate and 30 day mortality rate.
Reference 1 Longstreth GF. Epidemiology of hospitalisation for acute upper GI haemorrhage: a population-based study. Am J Gastroenterol 1995;90:206.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.