Results of a Prospective Study to Evaluate the Impact of Point‐of‐Care Ultrasound in the Enhancement of Gastrointestinal Bleeding Risk Scores

Abstract

Objectives Gastrointestinal (GI) bleeding is a common illness seen in the emergency department. The prognosis varies from self‐limited to potentially life threatening. Currently available GI bleeding risk scores have only a modest predictive value, limiting their wide implementation. The aim of this study was to assess the association and capability of point‐of‐care ultrasound (POCUS) used by emergency physicians to improve common GI bleeding scores for predicting complications and long‐term outcomes of patients with GI bleeding, which to our knowledge have never been studied. Methods Between August 2015 and April 2017, 203 hemodynamically stable patients with acute GI bleeding admitted to the emergency department were prospectively investigated. Using ultrasound, we measured the inferior vena cava diameter, cardiac output with surrogate markers such as the velocity time integral before and after the passive leg‐raising test, and the presence of systolic obliteration of the left ventricle. The Rockall and Glasgow‐Blatchford scores were calculated for patients with upper GI bleeding and the Velayos score for lower GI bleeding. The patients had follow‐up during hospitalization and 30 days later to assess for early and late adverse events (AEs). Then we integrated the ultrasound findings of hypovolemia into the GI bleeding scores, assessing the capability to detect AEs. Results In our cohort, patients with upper GI bleeding who showed left ventricle kissing walls had a worse evolution, with a greater presence of late AEs (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.32–10.96; P = .01). Patients with lower GI bleeding who showed a collapse of the inferior vena cava (>50%) after passive leg raising had a greater presence of early AEs (OR, 3.6; 95% CI, 1.46–9.00; P = .004). The predictive performance of the Rockall score (receiver operating characteristic analysis: area under the curve [AUC], 77.6%; 95% CI, 66.3%–88.8%) increased with POCUS (AUC, 80.3%; 95% CI, 69.5%–91.1%); that of the Glasgow‐Blatchford score (AUC, 72.5%; 95% CI, 59.9%–85.2%) increased with POCUS (AUC, 73.2%; 95% CI, 61.1%–85.4%); and that of Velayos score (AUC, 55.7%; 95% CI, 42.5%–69.0%) also increased with POCUS (AUC, 72.2%; 95% CI, 61.1%–83.3%). Conclusions The use of POCUS in GI bleeding is feasible and enhances common GI bleeding risk scores, showing better predictive performance in detecting AEs.

Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department

“…Evidence suggests that the combined use of the RS and GBS alongside ultrasonographic measurements outperforms the use of these scoring systems in isolation for predicting patient clinical outcomes. 19 Our findings indicate a significant inverse correlation between the GBS and SV (r: À0.7350; P < 0.0001), as depicted in Fig. 3.…”