Validation of a Modified Glasgow‐Blatchford Score for Risk Stratification of Patients with Suspected Upper Gastrointestinal Bleeding in an Accident and Emergency Department in Hong Kong

Abstract

Objectives To validate the use of a modified Glasgow-Blatchford Score (mGBS) for risk stratification of patients with suspected upper gastrointestinal bleeding (UGIB) in an accident and emergency department in Hong Kong. Methods This was a retrospective cohort study of patients who attended the emergency department of the study centre from January 2014 to June 2014 who were subsequently admitted to surgical wards with suspected UGIB. High risk patients were considered to be those who required in-patient clinical interventions (blood transfusion, therapeutic endoscopy, angiographic embolisation, or surgery). The mGBS was calculated for each patient. The sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) of the score were calculated. Results A total of 372 patients were included in the study. With an mGBS of 0 (low risk) for detecting the primary outcome, the sensitivity was 99.2% (95% CI, 95.6100%), and the specificity was 25.91 (95% CI 20.6-31.8%). The negative likelihood ratio was 0.031 (95% CI 0.004-0.2). The AUC was 0.90 (95% CI 0.87 to 0.93). Conclusion The modified Glasgow-Blatchford Score is a clinically useful tool for emergency physician to identify UGIB patients at low-risk of requiring in-hospital clinical interventions. (Hong Kong j.emerg.med. 2016;23:3-11)

The Predictive Value of Glasgow-Blatchford Score: The Experience of an Emergency Department

“…Regarding demographic and diagnosis characterization, our population shows to be similar to those described in other studies, with a higher percentage of male patients (62%), a mean age of 69 years old, and gastric and duodenal ulcers being the most frequent endoscopic diagnosis [10,11].…”

“…Thirty days after the first hemorrhagic event, 9.4% (n = 14) of patients returned to the ED due to hemorrhagic recurrence, which had a mean GBS value in the initial episode of 11.1 ± 3.2 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Nine patients (6%) died, three (2%) of them from a cause directly related to UGB (Table 2), showing values of 13, 14, and 17 in the GBS at the time of the initial hemorrhagic episode.…”

Comparison of Risk Stratification Scores for Patients Presenting with Symptoms of Upper Gastrointestinal Bleeding in the Emergency Department

“…A local study by Tsui et al on patients presenting to emergency department showed that using a cutoff score of 0 showed a high sensitivity of 99.2% (95% CI 95.6%-100%) and a negative likelihood ratio of 0.031 (95% CI 0.004-0.2) to rule out need for clinical intervention. 14 A good scoring system should be easy to be used by physicians and reproducible in different populations. Blatchford found the GBS useful since it could correctly identified those patients with potential serious bleeds that required treatment (99% sensitivity) and minor bleeds that do not require treatment (32% specificity).…”