Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention

Abstract

Background and Aim: Several scoring systems have been devised to identify patients with upper gastrointestinal (UGI) bleeding who are at a high risk of adverse outcomes. We retrospectively evaluated the accuracy of the Blatchford scoring system for assessing the need for clinical intervention in cases of UGI bleeding admitted to the emergency department (ED). Methods: This was a retrospective study conducted on patients who underwent emergency GI endoscopy at the ED of our hospital. Those who needed blood transfusion, operative or endoscopic interventions to control the hemorrhage were classified into the 'high risk' group. Results: Of the 93 enrolled patients, 70 (75.3%) were classified into the high risk group. The Blatchford score was significantly higher in the high risk group than in the low risk group. When a cut-off value of 2 was used, the sensitivity and specificity of the Blatchford scoring system were determined to be 100% and 13%, respectively. Thus, the Blatchford scoring system was deemed to be useful for distinguishing between the high risk group and the low risk group of patients with GI hemorrhage admitted to the ED. Conclusion: The Blatchford scoring system is accurate for identifying definitively lowrisk patients of GI hemorrhage, even prior to the performance of emergency UGI endoscopy at the ED.

Comparison of the AIMS-65 Score with the Glasgow-Blatchford Score in Upper Gastrointestinal Bleed in the Emergency Department

“…The score ranges from 0 to a maximum of 23 ( Table 1). The GBS had previously been validated with a suitable cutoff of less than 2 for low-risk patients (8,25,26).…”

Upper gastrointestinal bleeding risk scores: Who, when and why?

“…The greatest interest of clinical scores lies in their ability to identify patients at low risk of complications who are suitable for early discharge without endoscopy. There is considerable evidence from several geographical regions (both in the United Kingdom and around the world) [41,42,44,46,48,56] that the GBS is an excellent risk assessment tool and accurately identifies patients with a low risk of requiring intervention or death. However, the best GBS cut-off for these situations is not clearly defined.…”

“…The reported conclusion is that the modified GBS performed as well as the full GBS while outperforming both clinical and endoscopic Rockall Scores for prediction of clinical outcomes [51] . Some studies have suggested that the rate of identified lowrisk patients could be increased by using a higher GBS cut-off value [45,[52][53][54][55][56][57] or by incorporating age as a variable [52,58] .…”

“…Although with high sensitivity to identify patients at high risk for developing the need for blood transfusion, endoscopic therapy, or surgical intervention, the GBS has a low specificity [44,45,48,56,68,69] . Advanced age is a risk factor for death [70] and lowrisk patients in general are younger than high-risk patients with UGIB.…”

Emergency department risk stratification in upper gastrointestinal bleeding

“…In addition, this study did not calculate the negative predictive value of a GBS score of 0; however, the authors do refer to two studies that found a negative predictive value of 100%. 9,10 Of note, melena is a high-risk feature, and patients with hematemesis only but no melena can have a GBS of 0. This fact likely indicates that a large number and spectrum of patients present to the ED with ''hematemesis'' on their history, most of which is insignificant coffee ground emesis or spitting up of blood.…”