Diagnostic Value of the Glasgow-Blatchford Scoring System in Patients With Upper Gastrointestinal Bleeding
-
Omid Shadkam
,
Ali Bahari
,
Mohammadreza Farzanehfar
,
Ali Beheshti Namdar
,
Mitra Ahadi
,
Azita Ganji
,
Ladan Goshayeshi
,
Kambiz Akhavan Rezayat
Abstract
There are disagreements about the diagnostic value of the current risk stratification systems in patients with acute upper gastrointestinal bleeding (UGIB). The present study aimed to determine the diagnostic value of the Glasgow-Blatchford score in UGIB patients. This study was conducted on 182 patients with UGIB who underwent endoscopy in the Emergency Department of Imam Reza Hospital, Mashhad, Iran. Glasgow-Blatchford Score (GBS) of each patient was estimated by using the clinical and laboratory parameters. The relationship between Blatchford score and endoscopic findings was assessed. Additionally, the sensitivity and specificity of GBS were measured based on high- and low-risk patients. According to the results, GBS had a high sensitivity (90.9%), specificity (79%), as well as positive (76%), and negative predictive values (92.2%). However, no significant relationship was observed between the Glasgow-Blatchford score and re-bleeding. As the findings of the present study indicated, Glasgow-Blatchford was a good predictive method for the determination of the high-risk and low-risk patients with UGIB. Nevertheless, this method showed poor performance in the prediction of re-bleeding.
1. Van Leerdam M, Vreeburg E, Rauws E, Geraedts A, Tijssen J, Reitsma J, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003;98:1494-9.
2. Dalton D, Grant-Casey J, Hearnshaw S, Lowe D, Travis S, Rockall T. The UK comparative audit of upper gastrointestinal bleeding and the use of blood. National Blood Service. Oxford: UK, 2007.
3. Lewis JD, Bilker WB, Brensinger C, Farrar JT, Strom BL. Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990s: relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medications. Am J Gastroenterol 2002;97:2540-9.
4. Targownik LE, Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993–2003. Clin Gastroenterol Hepatol 2006;4:1459-66.
5. Zhao Y, Encinosa W. Hospitalizations for Gastrointestinal Bleeding in 1998 and 2006: Statistical Brief #65. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US), 2006.
6. Fallah MA, Prakash C, Edmundowicz S. Acute gastrointestinal bleeding. Med Clin North Am 2000;84:1183-208.
7. Corley DA, Stefan AM, Wolf M, Cook EF, Lee TH. Early indicators of prognosis in upper gastrointestinal hemorrhage. Am J Gastroenterol 1998;93:336-40.
8. Wong S, Yu L, Lau J, Lam Y, Chan A, Ng E, et al. prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer. Gut 2002;50:322-5.
9. Roushan N, Froutan H, Taslimi R, Kalani M, Ganji A, Moghaddam SD, et al. Double-balloon Enteroscopy: The results of a new experience in Iran. Med J Islam Repub Iran 2014; 28:19.
10. Sheasgreen C, Leontiadis GI. Recent advances in the management of patients with non-variceal upper gastrointestinal bleeding. Ann Gastroenterol 2013;26:191-7.
11. Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368:11-21.
12. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet. 2000;356:1318-21.
13. Stanley A, Ashley D, Dalton H, Mowat C, Gaya D, Thompson E, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009;373:42-7.
14. Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010;152:101-13.
15. Masaoka T, Suzuki H, Hori S, Aikawa N, Hibi T. Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. J Gastroenterol Hepatol 2007;22:1404-8.
16. Robins G, Sarwar M, Armstrong M, Denyer M, Bush S, Hassan T, et al. Evaluation of the need for endoscopy to identify low-risk patients presenting with an acute upper gastrointestinal bleed suitable for early discharge. Postgrad Med J 2007;83:768-72.
17. Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M, de Hierro ML, de Teresa J, Redondo-Cerezo E. 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. United European Gastroenterol J 2016;4:371-9.
18. Summerhayes M. National Institute for Health and Clinical Excellence. Encyclopedia of Cancer: Springer, 2011:2458-61.
19. Romagnuolo J, Barkun AN, Enns R, Armstrong D, Gregor J. Simple clinical predictors may obviate urgent endoscopy in selected patients with nonvariceal upper gastrointestinal tract bleeding. Arch Intern Med 2007;167:265-70.
20. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, et al. performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc 2013;78:576-83.
21. Schiefer M, Aquarius M, Leffers P, Stassen P, van Deursen C, Oostenbrug L, et al. Predictive validity of the Glasgow Blatchford Bleeding Score in an unselected emergency department population in continental Europe. Eur J Gastroenterol Hepatol 2012;24:382-7
22. Recio-Ramírez JM, Sánchez-Sánchez MP, Peña-Ojeda JA, Fernández-Romero E, Aguilera-Peña M, del-Campo-Molina E, et al. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department. Rev Esp Enferm Dig 2015;107:262-7.
23. Jerraya H, Bousslema A, Frikha F, Dziri C. Is there a place for the Glasgow-Blatchford score in the management of upper gastrointestinal bleeding? Tunis Med 2011;89:916-9.
24. Gralnek IM, Dulai GS. Incremental value of upper endoscopy for triage of patients with acute non-variceal upper-GI hemorrhage. Gastrointest Endosc 2004;60:9-14
2. Dalton D, Grant-Casey J, Hearnshaw S, Lowe D, Travis S, Rockall T. The UK comparative audit of upper gastrointestinal bleeding and the use of blood. National Blood Service. Oxford: UK, 2007.
3. Lewis JD, Bilker WB, Brensinger C, Farrar JT, Strom BL. Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990s: relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medications. Am J Gastroenterol 2002;97:2540-9.
4. Targownik LE, Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993–2003. Clin Gastroenterol Hepatol 2006;4:1459-66.
5. Zhao Y, Encinosa W. Hospitalizations for Gastrointestinal Bleeding in 1998 and 2006: Statistical Brief #65. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US), 2006.
6. Fallah MA, Prakash C, Edmundowicz S. Acute gastrointestinal bleeding. Med Clin North Am 2000;84:1183-208.
7. Corley DA, Stefan AM, Wolf M, Cook EF, Lee TH. Early indicators of prognosis in upper gastrointestinal hemorrhage. Am J Gastroenterol 1998;93:336-40.
8. Wong S, Yu L, Lau J, Lam Y, Chan A, Ng E, et al. prediction of therapeutic failure after adrenaline injection plus heater probe treatment in patients with bleeding peptic ulcer. Gut 2002;50:322-5.
9. Roushan N, Froutan H, Taslimi R, Kalani M, Ganji A, Moghaddam SD, et al. Double-balloon Enteroscopy: The results of a new experience in Iran. Med J Islam Repub Iran 2014; 28:19.
10. Sheasgreen C, Leontiadis GI. Recent advances in the management of patients with non-variceal upper gastrointestinal bleeding. Ann Gastroenterol 2013;26:191-7.
11. Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368:11-21.
12. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet. 2000;356:1318-21.
13. Stanley A, Ashley D, Dalton H, Mowat C, Gaya D, Thompson E, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009;373:42-7.
14. Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010;152:101-13.
15. Masaoka T, Suzuki H, Hori S, Aikawa N, Hibi T. Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. J Gastroenterol Hepatol 2007;22:1404-8.
16. Robins G, Sarwar M, Armstrong M, Denyer M, Bush S, Hassan T, et al. Evaluation of the need for endoscopy to identify low-risk patients presenting with an acute upper gastrointestinal bleed suitable for early discharge. Postgrad Med J 2007;83:768-72.
17. Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M, de Hierro ML, de Teresa J, Redondo-Cerezo E. 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. United European Gastroenterol J 2016;4:371-9.
18. Summerhayes M. National Institute for Health and Clinical Excellence. Encyclopedia of Cancer: Springer, 2011:2458-61.
19. Romagnuolo J, Barkun AN, Enns R, Armstrong D, Gregor J. Simple clinical predictors may obviate urgent endoscopy in selected patients with nonvariceal upper gastrointestinal tract bleeding. Arch Intern Med 2007;167:265-70.
20. Bryant RV, Kuo P, Williamson K, Yam C, Schoeman MN, Holloway RH, et al. performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc 2013;78:576-83.
21. Schiefer M, Aquarius M, Leffers P, Stassen P, van Deursen C, Oostenbrug L, et al. Predictive validity of the Glasgow Blatchford Bleeding Score in an unselected emergency department population in continental Europe. Eur J Gastroenterol Hepatol 2012;24:382-7
22. Recio-Ramírez JM, Sánchez-Sánchez MP, Peña-Ojeda JA, Fernández-Romero E, Aguilera-Peña M, del-Campo-Molina E, et al. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department. Rev Esp Enferm Dig 2015;107:262-7.
23. Jerraya H, Bousslema A, Frikha F, Dziri C. Is there a place for the Glasgow-Blatchford score in the management of upper gastrointestinal bleeding? Tunis Med 2011;89:916-9.
24. Gralnek IM, Dulai GS. Incremental value of upper endoscopy for triage of patients with acute non-variceal upper-GI hemorrhage. Gastrointest Endosc 2004;60:9-14
| Files | ||
| Issue | Vol 58, No 12 (2020) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v58i12.5152 | |
| Keywords | ||
| Upper gastrointestinal bleeding Endoscopy Glasgow-Blatchford score | ||
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How to Cite
1.
Shadkam O, Bahari A, Farzanehfar M, Beheshti Namdar A, Ahadi M, Ganji A, Goshayeshi L, Akhavan Rezayat K. Diagnostic Value of the Glasgow-Blatchford Scoring System in Patients With Upper Gastrointestinal Bleeding. Acta Med Iran. 2021;58(12):616-620.
