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The Predictive Value of Glasgow-Blatchford Score: The Experience of an Emergency Department
Penélope Correia1, Ana Spínola2, Joana F Correia3
1General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT.
Insights
The Glasgow-Blatchford score (GBS) effectively identifies low-risk patients with upper gastrointestinal bleeding (UGB) for outpatient management. A threshold of GBS ≤3 demonstrated high sensitivity for predicting intervention needs and complications.
Area of Science:
- Emergency Medicine
- Gastroenterology
- Clinical Risk Stratification
Background:
- Upper gastrointestinal bleeding (UGB) is a significant cause of mortality and morbidity globally.
- Accurate early assessment is crucial for managing UGB patients.
- The Glasgow-Blatchford score (GBS) is recommended for risk stratification in the emergency department (ED).
Purpose of the Study:
- To evaluate the validity of the Glasgow-Blatchford score (GBS) for risk stratification of UGB patients in an ED setting.
Main Methods:
- Retrospective analysis of 149 patients diagnosed with UGB in the ED between 2017 and 2018.
Main Results:
- The mean GBS was 10.3.
- A GBS threshold of ≤3 showed high sensitivity (98.9%) for intervention needs and perfect sensitivity (100%) for 30-day complications.
- The GBS demonstrated an area under the curve of 0.883 for interventions and 0.625 for complications.
Conclusions:
- A GBS threshold of ≤2 or ≤3 can identify more low-risk UGB patients suitable for outpatient management.
- This approach did not significantly increase intervention needs or 30-day complications.
Introduction:
Upper gastrointestinal bleeding (UGB) is a common emergency and a major cause of morbidity and mortality worldwide. An early and accurate assessment at admission is essential to estimate the severity of each case, assisting in the management of patients. The Glasgow-Blatchford score (GBS) is currently recommended for risk stratification of UGB in the emergency department (ED), helping triage patients to in-hospital vs. ambulatory management. The aim of this study was to test the validity of the GBS in an ED.
Methods:
Patients who presented to the ED with a diagnosis of UGB between 2017 and 2018 were retrospectively analyzed.
Results:
The mean GBS value of the 149 patients included in the study was 10.3. Of the patients, 4.3% had values ≤1 and 8.7% had values ≤3. The sensitivity and negative predictive value for intervention needs (98.9% and 91.7%) and complications in 30 days (100% and 100%) remained high with a threshold ≤3. In the receiver operating characteristic curves, GBS presented an area under the curve of 0.883 and 0.625, regarding the need for intervention and complications in 30 days, respectively.
Conclusions:
In our population, the threshold ≤2, and eventually ≤3, allows the identification of twice as many low-risk patients, manageable as outpatients, without significant increases in intervention needs or complications in 30 days.
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