Comparing the Blatchford and pre-endoscopic Rockall score in predicting the need for endoscopic therapy in patients with upper GI hemorrhage

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

“…In this cohort of patients the 28 d mortality rate was 0 [43] . The GBS has been shown to be as good as the Rockall score in predicting the need for any intervention, namely the need for therapeutic endoscopy [41,42,[44][45][46][47] . The GBS has also been shown to be superior to the clinical Rockall score in identifying patients with suspected UGIB who have a low likelihood of an adverse clinical outcome (blood transfusion, endoscopic therapy, interventional radiology, surgery or 30 d mortality) and can be considered for early discharge [48] .…”

“…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.…”

Risk assessment in patients with gastrointestinal bleeding

“…9 Some studies have demonstrated that clinical decisions made by certified emergency physicians are also important and perhaps more useful than using a GI bleeding score tool in triage decisions either to admit the patient or to discharge the patient to outpatient evaluation. 10,11 However, there has only been one clinical study in the US regarding the use of a GI bleeding scoring system to triage into an ICU or non-ICU bed. 12 upper Gi bleeDinG sCorinG systems 1.…”

“…14 However, another study demonstrated that the GBS is more effective than the pre-endoscopic Rockall score. 11 Since the complete Rockall score requires endoscopy results for its scoring, it cannot be utilized in the clinical settings where endoscopy cannot be performed soon after evaluation in the emergency room. Clinical evaluation and the use of a clinical scoring system such as the pre-endoscopic Rockall score would help triage this group of patients.…”

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“…A score of zero yields a negative predictive value greater than 99 % for requiring endoscopic intervention, blood transfusion, surgery or death [11]; these patients can be safely cared for without hospitalization [3]. Various professional society guidelines advocate using the GBS to identify low risk patients [2, 12 -14], and an international consortium on the management of non-variceal UGIB proposed risk stratification of patients as a quality indicator [15].…”