Description

Introduction: Risk stratification of patients with
suspected upper gastrointestinal bleeding (UGIB) using
either Glasgow-Blatchford Bleeding Score (GBS) or preendoscopy
Rockall score to facilitate early safe discharge
(GBS=0, pre-Rockall=0) has been reported. This
observational study compared score utility and considered the
impact of extending the range of GBS or pre-Rockall scores
permitting safe discharge.

Methods: Consecutive adult patients presenting to
acute medical admissions or the emergency department from
September 2008-March 2009 with suspected UGIB had
clinical history, vital signs, laboratory and endoscopy results
prospectively recorded using electronic databases. GBS,
pre-Rockall scores and a composite endpoint (blood
transfusion, endoscopic therapy, interventional radiology,
surgery or 30-day mortality) were calculated.

Results: 388 patients with suspected UGIB were
identified of which 92.3% were admitted (median (range)
GBS=5 (0-19) and pre-Rockall=2 (0-11)) and 7.7%
discharged (GBS=0 (0-4) and pre-Rockall=0 (0-4)). 186
(47.9%) underwent in-patient endoscopy. 151 (38.9%)
were found to have the composite endpoint with 77.5%
having transfusion, 45.7% endoscopic treatment and an
8.0% mortality within 30 days. AUROC (95% CI) for
30-day composite endpoint was 0.92 (0.89-0.94) using
GBS and 0.75 (0.70-0.80) using pre-Rockall scores.
Analysis using different GBS thresholds demonstrated that
GBS=0, GBS ≤1 and GBS≤2 had superior utility in
identifying freedom from an adverse clinical outcome at
30-days than pre-Rockall score 0.

Conclusions: GBS is superior to pre-Rockall score in identifying patients with suspected UGIB who have a low
likelihood of an adverse clinical outcome and can be
considered for early discharge. Diagnostic performance at
different thresholds suggests that patients with GBS≤2
could be considered for early discharge, doubling the number
of eligible patients (15.2 to 32.5%). This has important
patient safety and resource implications.