Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding


CLINICAL QUESTION: What are the accuracy and clinical utility of risk scoring systems in the assessment of patients with upper gastrointestinal (GI) bleeding?

BACKGROUND: There are several pre- and postendoscopy risk scores to predict clinically relevant outcomes such as transfusion, mortality, endoscopy treatment, surgery, and length of hospital stay for upper GI bleeding. The accuracy and applicability of these risk scores has not been well established.

STUDY DESIGN: International multicenter prospective study.

SETTING: Six large hospitals in Europe, North America, Asia, and Oceania.

SYNOPSIS: This is a prospective study comparing three pre-endoscopy scoring systems (Rockall, AIMS65, Glasgow Blatchford) and two postendoscopy scoring systems (PNED, full Rockall) in 3,012 patients with upper GI bleeding over six hospitals. It examined clinically relevant outcomes: intervention (transfusion, endoscopy, interventional radiology, surgery), mortality, rebleeding, and length of hospital stay.

The Glasgow Blatchford risk score was the most accurate at predicting the need for hospitalization and death across all hospitals, compared with the other scoring systems. It was determined that a Glasgow Blatchford score of less than 1 is an optimal threshold for outpatient management, with a 98.6% sensitivity in identifying those who would not require intervention or die. The utility of these scores to direct management in high-risk patients is limited and needs further studies. No scoring system predicted rebleeding or length of hospital stay.

A weakness of the study is that patients who bled while already inpatients were excluded.

BOTTOM LINE: The Glasgow Blatchford risk score can help direct care of very low risk patients (score, less than 1) with upper GI bleeding toward outpatient management.

CITATIONS: Stanley AJ, Laine L, Dalton HR, et al. “Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: International multicenter prospective study.” BMJ. 2017 Jan 4;356:i6432.

Dr. Tsien is assistant professor in the division of hospital medicine, Loyola University Chicago, Maywood, Ill.

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