» Grady Report

Lit of the Week – 5/3/16

Glasgow Blatchford Bleeding Score

Clinical question / background:

Can a risk score based on medical history, hemodynamic variables, and simple lab data risk stratify patients presenting with upper GI bleed to the emergency department?

Design:

Retrospective development of scoring system using logistic regression of objective data from large patient database followed by prospective validation using ROC curves compared to Rockall scoring and post-endoscopy scores
1748 patients with UGIB in retrospective group
- 19 hospitals in Scotland
197 patients with UGIB in validation group
- 2 hospitals in Scotland
Primary outcome: clinical intervention
- Blood transfusion
- Any operative or endoscopic procedure to control bleeding
- Death, re-bleed, or substantial fall in hemoglobin after admission

Intervention:

Glasgow-Blatchford Score
Admission risk marker	Score component value
Blood Urea (mmol/L)
6.5-8.0	2
8.0-10.0	3
10.0-25	4
>25	6
Hemoglobin (g/L) for men
12.0-12.9	1
10.0-11.9	3
<10.0	6
Hemoglobin (g/L) for women
10.0-11.9	1
<10.0	6
Systolic blood pressure (mm Hg)
100–109	1
90–99	2
<90	3
Other markers
Pulse ≥100 (per min)	1
Presentation with melena	1
Presentation with syncope	2
Hepatic disease	2
Cardiac failure	2

Score is equal to “0” if the following are all present:

Results:

area under the ROC curve of GB score was 0·92 (95% CI 0·88–0·95), which was significantly higher than that for Rockall admission (0·71 [0·64–0·78]) and the full postendoscopy scores (0·75 [0·67–0·83]
GB score more highly correlated with need for blood transfusion and hospital length of stay

Take-Home

In patients presenting with signs/sxs of acute UGIB, the GB score can be used to risk stratify them for need for further intervention

Strengths:

Easy to use based on common admission lab data
META-analysis found that score of 0 was associated with a low likelihood of the need for urgent endoscopic intervention (likelihood ratio 0.02, 95% confidence interval [CI] 0-0.05)

Limitations

Only applicable for acute UGIB
Score of 1 or greater indicates probable need for intervention limiting its use if patients with chronic anemia, renal disease

Real World

Score 0
- Low risk for intervention
- Reasonable to manage as outpatient
Score >0
- Increased risk for intervention and inpatient management is recommended
- However most cases <5 respond without significant intervention
Score >5
- High risk for intervention

Lit of the Week — 5/3/16