Scoring systems for peptic ulcer bleeding: Which one to use?

Abstract

AIMTo compare the Glasgow-Blatchford score (GBS), Rockall score (RS) and Baylor bleeding score (BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers.METHODSBetween January 2008 and December 2013, 1012 consecutive patients admitted with peptic ulcer bleeding (PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores (RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics (AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were evaluated.RESULTSPUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome (AUROC 0.82 vs 0.67 vs 0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality (AUROC 0.84 vs 0.57 vs 0.64), rebleeding (AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion (AUROC 0.83 vs 0.63 vs 0.58) and surgical intervention (0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome (AUROC 0.82 vs 0.69, respectively).CONCLUSIONThe RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one 'perfect score' and we suggest that these two tests be used concomitantly.

British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding

“…We recommend that patients with gbs ≤1 at presentation are considered for outpatient management Level of evidence: Moderate Level of recommendation: Strong Agreement: 100% Agreement Bundle recommendation: Consider discharge if GBS 0 or 1 (100% agreement) Several comparative studies have assessed preendoscopy and postendoscopy risk scores in AUGIB. [38][39][40][41][42][43][44][45][46][47][48][49] These studies confirm GBS is the best at predicting the clinically important composite end point of need for hospital-based intervention (transfusion, endoscopic therapy, interventional radiology, surgery) or death, with high sensitivity at 98.6%. 39 The clinical utility of existing risk scores to identify patients at high risk of poor outcomes appear limited.…”

Comparison of Glasgow-Blatchford Score and Rockall Score in Patients with Upper Gastrointestinal Bleeding

“…Budimir I. et al concluded that there is no one ‘perfect score’ and the best option is to use more than one scoring system concomitantly. RS is the best predictor of mortality and GBS is the best predictor of a need for blood transfusion ( 20 ).…”

Correlation between the Glasgow-Blatchford score, shock index, and Forrest classification in patients with peptic ulcer bleeding

“…The European Society of Gastrointestinal Endoscopy has recommended assessment using the GBS before endoscopy, with low-risk (GBS 0-1) patients not requiring early endoscopy or hospitalization [17]. Some studies have found that the GBS can better predict rebleeding in patients with upper gastrointestinal bleeding [18][19][20], and a high GBS (GBS > 7) is associated with the risk of rebleeding [21].…”