Predictive validity of the Glasgow Blatchford Bleeding Score in an unselected emergency department population in continental Europe

Schiefer, Mart; Aquarius, Michèl; Leffers, Pieter; Stassen, Patricia M.; Deursen, C. van; Oostenbrug, Liekele E.; Jansen, Loes; Masclee, Ad; Keulemans, Yolande C.A.

doi:10.1097/meg.0b013e3283505965

Cited by 27 publications

(56 citation statements)

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“…10,[14][15][16][17] Nevertheless, further studies have shown the utility of the GBS in predicting death, blood transfusion, endoscopic intervention, and surgery. [14][15][16][17][18] The main drawback of the GBS and the RS is their difficult day to day application, which has reduced their role to research protocols. Thus, the AIMS65 has recently been validated to predict in-hospital mortality, length of stay, and costs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality

Martínez-Cara

Jiménez-Rosales

Úbeda-Muñoz

et al. 2015

United European Gastroenterology Journal

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Objective: AIMS65 is a score designed to predict in-hospital mortality, length of stay, and costs of gastrointestinal bleeding. Our aims were to revalidate AIMS65 as predictor of inpatient mortality and to compare AIMS65's performance with that of Glasgow-Blatchford (GBS) and Rockall scores (RS) with regard to mortality, and the secondary outcomes of a composite endpoint of severity, transfusion requirements, rebleeding, delayed (6-month) mortality, and length of stay. Methods: The study included 309 patients. Clinical and biochemical data, transfusion requirements, endoscopic, surgical, or radiological treatments, and outcomes for 6 months after admission were collected. Clinical outcomes were in-hospital mortality, delayed mortality, rebleeding, composite endpoint, blood transfusions, and length of stay. Results: In receiver-operating characteristic curve analyses, AIMS65, GBS, and RS were similar when predicting inpatient mortality (0.76 vs. 0.78 vs. 0.78). Regarding endoscopic intervention, AIMS65 and GBS were identical (0.62 vs. 0.62). AIMS65 was useless when predicting rebleeding compared to GBS or RS (0.56 vs. 0.70 vs. 0.71). GBS was better at predicting the need for transfusions. No patient with AIMS65 ¼ 0, GBS 6, or RS 4 died. Considering the composite endpoint, an AIMS65 of 0 did not exclude high risk patients, but a GBS 1 or RS 2 did. The three scores were similar in predicting prolonged in-hospital stay. Delayed mortality was better predicted by AIMS65. Conclusion: AIMS65 is comparable to GBS and RS in essential endpoints such as inpatient mortality, the need for endoscopic intervention and length of stay. GBS is a better score predicting rebleeding and the need for transfusion, but AIMS65 shows a better performance predicting delayed mortality.

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Section: Introductionmentioning

confidence: 99%

Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality

Martínez-Cara

Jiménez-Rosales

Úbeda-Muñoz

et al. 2015

United European Gastroenterology Journal

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“…10 The GBS has been shown to predict composite outcomes of rebleeding, in-hospital mortality, endoscopic or surgical intervention, and blood transfusions. 11 Some studies have shown that the GBS outperforms the RS in predicting interventions or composite clinical outcomes. [12][13][14] Research has also demonstrated that it is superior to the RS in identifying patients with low-risk upper GI bleeding requiring no intervention who might be safely managed as outpatients.…”

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confidence: 99%

Comparison of the Glasgow‐Blatchford and AIMS65 Scoring Systems for Risk Stratification in Upper Gastrointestinal Bleeding in the Emergency Department

Yaka

Yılmaz

Doğan

et al. 2014

Academic Emergency Medicine

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ObjectivesThe aim of this study was to compare the performance of the Glasgow‐Blatchford and the AIMS65 scoring systems as early risk assessment tools for accurately identifying patients with upper gastrointestinal (GI) bleeding who are at a low risk of requiring clinical interventions, including emergency endoscopy. The secondary objective was to compare their performance regarding relevant clinical outcomes.MethodsData were collected prospectively over a 2‐year period in the emergency department of a university hospital. Adult patients with upper GI bleeding from either variceal or nonvariceal sources were included. Composite clinical outcomes consisted of a need for surgical or endoscopic intervention, rebleeding, intensive care unit admission, or in‐hospital mortality. Patients who required blood transfusions or suffered composite clinical outcomes were considered high‐risk patients. Glasgow‐Blatchford score (GBS) and AIMS65 score were calculated for each patient. The sensitivity and specificity of the scoring systems were calculated. The areas under the receiver‐operating characteristic curve (AUC) of the scores were compared.ResultsThere were 254 patients in the study, of whom 163 (64.2%) were men. The median age was 61 years (interquartile range = 45 to 72 years). Among the patients, 211 (83.1%) underwent endoscopy, of whom 49 (19.3%) required endoscopic intervention to achieve hemostasis. Five (2%) patients required surgical intervention. Rebleeding was observed in 33 (13%) patients. A total of 143 (56.3%) patients received blood transfusions. A total of 152 (59.8%) were defined as high risk. Eighty‐one (31.9%) experienced at least one component of the composite clinical outcomes, 18 (7.1%) of whom suffered in‐hospital mortality. A GBS of 0 was observed in 16 patients (6.3%) in the study group. Two of these were high‐risk patients. A total of 101 (39.8%) patients had AIMS65 scores of 0. Thirty‐four of these were high‐risk patients. A GBS of 0 had higher sensitivity than an AIMS65 score of 0 (98.68% vs. 77.6%). The negative predictive values of the GBS and AIMS65 of 0 were 87.5 and 66.3%, respectively. The GBS and AIMS65 were similar with regard to the composite outcome prediction, with AUCs of 0.795 (95% confidence interval [CI] = 0.74 to 0.843) and 0.746 (95% CI = 0.688 to 0.798), respectively (p = 0.137). The scores were also similar with respect to predicting in‐hospital mortality (AUCs of 0.85 vs. 0.81; p = 0.342). The GBS was superior to the AIMS65 in identifying high‐risk patients, with AUCs of 0.896 (95% CI = 0.85 to 0.93) and 0.771 (95% CI = 0.714 to 0.821; p < 0.001), respectively. The GBS was also more accurate than the AIM65 in predicting the need for blood transfusions (AUCs of 0.904 vs. 0.796; p < 0.001) and interventions (AUCs of 0.727 vs. 0.647; p = 0.05).ConclusionsThese results suggest that the GBS has superior sensitivity relative to the AIMS65 in identifying patients who were not likely to require interventions, including emergency endoscopy. Additional work to determine the use in real‐time decision making may be warranted and helpful in providing guidance to clinicians.

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“…Previous studies, including many from Europe, have demonstrated that a high percentage of low-risk UGIB patients are admitted [3,10,31]. A more recent analysis from New Zealand found only 1 % of patients presenting to the ED with complaints of UGIB had a GBS of 0 [32]; an earlier study in the United States found only 4 % of patients admitted for management of UGIB were low risk by GBS criteria [17].…”

Section: Discussionmentioning

confidence: 95%

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2017

Endosc Int Open

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Predictive validity of the Glasgow Blatchford Bleeding Score in an unselected emergency department population in continental Europe

Cited by 27 publications

References 20 publications

Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality

Comparison of AIMS65, Glasgow–Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality

Comparison of the Glasgow‐Blatchford and AIMS65 Scoring Systems for Risk Stratification in Upper Gastrointestinal Bleeding in the Emergency Department

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