Why Use Use for adult patients being considered for hospital admission due to upper GI bleeding. Its use is controversial for patients already admitted, as very few were represented in the original cohort and many of these patients receive endoscopic evaluation. Any of the 9 variables, if present, increase the priority for admission and likelihood of need for acute intervention. Scores range from , with higher scores corresponding to increasing acuity and mortality. A score of 0 suggests low risk of complications 0.
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Pinterest Glasgow Blatchford score Glasgow Blatchford score was developed in to predict the need for hospital-based intervention transfusion, endoscopic therapy or surgery or death following upper-gastrointestinal bleeding 1.
Nevertheless, the classification of patients as low risk might not always be accurate. As the Glasgow—Blatchford score enables the identification of patients who might need intervention, this score is considered to be preferable to the pre-endoscopic clinical Rockall score not to be confused with the complete Rockall score, which includes both clinical and endoscopic variables, such as diagnosis of the lesion and stigmata of recent hemorrhage 5 , which can only accurately predict the risk of mortality and is less accurate than the Glasgow—Blatchford score for predicting rebleeding or the need for surgery 6.
Nevertheless, the pre-endoscopic Rockall score is better than the complete Rockall score for prediction of rebleeding and mortality in patients with cirrhosis and variceal bleeding at least among patients with upper-gastrointestinal bleeding 7.
Although the use of such scores is strongly encouraged by professional organizations, such as the British Society of Gastroenterology 8 , whose guidelines advise that all patients with suspected upper-gastrointestinal bleeding should undergo risk scoring as part of their initial assessment on presentation, the benefit of these scores in daily clinical practice has been questioned.
An independent team of researchers who conducted validation studies of both the Glasgow Blatchford score and Rockall scores both the pre-endoscopic and complete scores did not recommend their use in the clinical setting Categories of high risk lesions include actively spurting Forrest class Ia , oozing blood Forrest class Ib , nonbleeding visible vessels Forrest class IIa and adherent clot Forrest class IIb Table 1.
Table 2. Modified Glasgow Blatchford score Footnote: Glasgow Blatchford score and modified Glasgow Blatchford score scoring systems have similar accuracy in prediction of the probability of re-bleeding, need for blood transfusion, surgery and endoscopic intervention, hospitalization in intensive care unit, and mortality of patients with acute upper gastrointestinal bleeding The Glasgow-Blatchford Score has been shown to be accurate at predicting the need for intervention and death in acute upper-gastrointestinal bleeding in a variety of populations For example, the results of one study suggested that patients with a Glasgow—Blatchford score above the threshold value of 12 are the most likely to benefit from early endoscopy UK National Institute for health and Care Excellence guidelines have recommended early discharge without endoscopy for patients with a Blatchford score of 0 due to the high negative predictive value of the Glasgow Blatchford score and therefore the safety of discharging patients who have a Glasgow Blatchford score of 0 UK National Institute for health and Care Excellence guidelines have recommended early discharge without endoscopy for patients with an acute upper-gastrointestinal bleeding and a Glasgow-Blatchford Score of 0 There is therefore controversy as to the optimal Glasgow Blatchford score cut-off for discharge and little evidence on how an extended score performs in routine clinical practice when clinicians use the cut-off to discharge patients with acute upper-gastrointestinal bleeding What are the new findings?
This adds weight to the recommendations made in recent international guidelines. How might it impact on clinical practice in the foreseeable future? A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet ; 3. Acute nonvariceal upper gastrointestinal bleeding. Outpatient management of nonvariceal upper gastrointestinal hemorrhage: unexpected mortality in Medicare beneficiaries. Gastroenterology , — Risk assessment after acute upper gastrointestinal haemorrhage.
Gut 38, — World J. Predictive value of Rockall score for rebleeding and mortality in patients with variceal bleeding. Physicians Surg. Scope for improvement: a toolkit for a safer upper gastrointestinal bleeding UGIB service.
Education and imaging. Gastrointestinal: aneurysmal artery in a gastric ulcer after endoscopic hemostasis. Clinical triage decision vs risk scores in predicting the need for endotherapy in upper gastrointestinal bleeding. Management of acute bleeding from a peptic ulcer. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding.
Endoscopy in gastrointestinal bleeding. Lancet 2, — Emerg Tehran. Lancet , 42—47 Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. Published Jan 4. Endoscopy 43, — Acute upper gastrointestinal bleeding in over 16s: management. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation.
Lancet ;—7. Discharge of patients with an acute upper gastrointestinal bleed from the emergency department using an extended Glasgow-Blatchford Score. BMJ Open Gastroenterol. Published Aug Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update Gut Outpatient management of low-risk patients with upper gastrointestinal bleeding: can we safely extend the Glasgow Blatchford Score in clinical practice?
Eur J Gastroenterol Hepatol ;—5. The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol ;—5.
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This health tool allows the stratification of patients at risk for bleeding in the upper gastro intestinal track and helps the clinician set the inpatient or outpatient management. The higher Hb value, the less risk for bleeding. One of the criticisms of the Blatchford bleeding model is that it can only be used for patient with upper GI bleeding and not for lower GI where the source of hemorrhage might not be clear. Another useful score used in gastrointestinal bleeding management is the pre endoscopic Rockall score , for mortality risk but in comparison to the Glasgow Blatchford, although both systems can be assessed at first presentation, the Rockall one is a lot more subjective with the clinician being allowed to assess the severity of systemic disease while Blatchford focuses on symptoms. Blatchford score interpretation Once the risk stratification system is completed, the clinician will obtain a score ranging from 0 to Scores of 0 are considered low risk while all scores above 0 are deemed high risk for upper gastro intestinal bleeding. Low risk patients even suffering from hematemesis can be monitored outpatient but are still in need for endoscopy, although in their case is rather elective than compulsory.