Is there a place for the Glasgow-Blatchford score in the management of upper gastrointestinal bleeding?

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Published Dec 20, 2011
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Vol. 89 No. (2011): Issue Dec 2011

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Hichem Jerraya
Amine Bousslema
Foued Frikha
Chadli Dziri

Abstract

Background: Upper gastrointestinal bleeding is a frequent cause for emergency hospital admission. Most severity scores include in their computation the endoscopic findings. The Glasgow-Blatchford score is a validated score that is easy to calculate based on simple clinical and biological variables that can identify patients with a low or a high risk of needing a therapeutic (interventional endoscopy, surgery and/ or transfusions).
Aim: To validate retrospectively the Glasgow-Blatchford Score (GBS).
Methods: The study examined all patients admitted in both the general surgery department as of Anesthesiology of the Regional Hospital of Sidi Bouzid. There were 50 patients, which the mean age was 58 years and divided into 35 men and 15 women. In all these patients, we calculated the GBS. Series were divided into 2 groups, 26 cases received only medical treatment and 24 cases required transfusion and / or surgery. Univariate analysis was performed for comparison of these two groups then the ROC curve was used to identify the 'Cut off point' of GBS. Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) with confidence interval 95% were calculated.
Results: The SGB was significantly different between the two groups (p <0.0001). Using the ROC curve, it was determined that for the threshold of GBS ³ 7, Se = 96% (88-100%), Sp = 69% (51-87%), PPV = 74% (59 -90%) and NPV = 95% (85-100%). This threshold is interesting as to its VPN. Indeed, if GBS <7, we must opt for medical treatment to the risk of being wrong in only 5% of cases.
Conclusion: The Glasgow-Blatchford score is based on simple clinical and laboratory variables. It can recognize in the emergency department the cases that require medical treatment and those whose support could need blood transfusions and / or surgical treatment.

Keywords:

Risk scoring, re bleeding, transfusion, surgery

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References

  1. Hochain P. Épidémiologie des hémorragies digestives aiguës. Prise en charge des hémorragies digestives. Paris: Masson; 2002.
  2. Atkinson RJ, Hurlstone DP. Usefulness of prognostic indices in upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2008; 22: 233-42.
  3. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000; 356: 1318-21.
  4. Edelmann G, Boutelier P, Brenot J, Schmitt R. Treatment of massive gastroduodenal hemorrhage (portal hypertension excepted). Mem Acad Chir (Paris). 1966; 16; 92: 304-15.
  5. Rockall TA, Logan RFA, Devlin HB et al. Risk Assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316-21.
  6. Saeed ZA, Ramirez FC, Hepps KS et al. Prospective validation of the Baylor bleeding score for predicting the likelihood of rebleeding after endoscopic hemostasis of peptic ulcers. Gastrointest Endosc 1995; 41: 561-5.
  7. Silverstein FE, Gilbert DA, Tedesco FJ, et al. The national ASGE survey on upper gastrointestinal bleeding, II: clinical prognostic factors. Gastrointest Endosc 1981; 27: 80-93.
  8. Pumphrey CW, Beck ER. Raised blood urea concentration indicates considerable blood loss in acute upper gastrointestinal haemorrhage. BMJ 1980; 280: 527-28.
  9. Dejong CH, Meijerink WJ, van Berlo CL, Deutz NE, Soeters PB. Decreased plasma isoleucine concentrations after upper gastrointestinal haemorrhage in humans. Gut 1996; 39: 13-17.
  10. Chen IC, Hung MS, Chiu TF et al. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med 2007; 25: 774-79.
  11. Masaoka T, Suzuki H, Hori S et al. Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. J Gastroenterol Hepatol 2007; 22: 1404-8.
  12. Pang SH, Ching JYL, Lau JYW et al. Comparing the Blatchford and pre-endoscopic Rockall score in predicting the need for endoscopic therapy in patients with upper GI hemorrhage. Gastrointest Endosc 2010; 71: 1134-40.
  13. Stanley AJ, Ashley D, Dalton HR et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation.
  14. Sung JJ, Chan FK, Chen M et al. Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding. Gut 2011; 60: 1170-7.