Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding

New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding

“…A ≤ 2 Rockall score is associated with a rebleeding rate of 3.5-5.3% and a mortality of 0.2%, while a ≥ 8 score is related with a rebleeding rate of 41.8% and a mortality rate of 41.1% (22). A subsequent study confirmed the ability of the Rockall score to predict mortality but not to predict rebleeding (23).…”

Use of capsule endoscopy in the emergency department as a triage of patients with GI bleeding

“…Recent studies have shown that a GBS 1 or 2 can effectively identify patients with low-risk UGIB, and hence those patients can be managed on an outpatient basis. 9,10 In prospective observational studies, only 11% to 14% of patients were found to have a GBS score equal to zero and considered safe to send home. 3,4 When GBS is used as a triage tool, hospital admission can be reduced by 15% to 20%.…”

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

“…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] .…”

“…Over a 5-year period of managing such patients without hospital admission, McLaughlin et al [43] showed that any of them required endoscopic intervention, blood transfusion or surgery, and that the 28 d mortality was nil. A recent multicentre Danish study reported that a GBS cut-off value of ≤ 1 and an age modified low-risk version can be safely and effectively used to reduce unnecessary admissions for suspected UGIB [55] . AIMS65 can potentially be used to predict in-hospital mortality, length of stay, and cost in patients with acute UGIB [23] .…”

“…Furthermore, no clinicians will feel comfortable in managing an elderly patient as an outpatient even if he has a GBS of 0. When there is clinical concern on avoiding admission in elderly patients, the use of an age modified GBS should be considered [55] .…”