Evaluating The Glasgow Blatchford Score for Upper Gastrointestinal Bleeding Risk Stratification in A Community...

Area of Science:

• Gastroenterology
• Clinical Risk Stratification
• Medical Informatics

Background:

• Upper gastrointestinal bleeding (UGIB) is a common gastroenterological emergency.
• The Glasgow Blatchford Score (GBS) is a tool for risk stratification in UGIB.
• Current GBS cutoff values for predicting intervention, treatment, and mortality lack consistency.

Purpose of the Study:

• To determine the relationship between mean GBS scores and the need for hemostatic intervention and blood transfusion.
• To evaluate the quality of care and resource allocation for UGIB patients.
• To assess the utility of GBS in a midwestern community hospital setting.

Main Methods:

• Retrospective cross-sectional study of patients (≥18 years) admitted for UGIB and undergoing esophagogastroduodenoscopy (July 2018-July 2020).
• Calculation of GBS for each patient.
• Multivariate analysis and logistic regression to predict GBS score, odds ratio, and association with hemostatic intervention and blood transfusion, controlling for confounders.

Main Results:

• The mean GBS was 11.17.
• Patients requiring hemostatic intervention (mean GBS 13.18) and blood transfusion (mean GBS 13.57) had significantly higher scores.
• A GBS >10 was associated with increased odds of blood transfusion (OR 21.84) and hemostatic intervention (OR 5.085).
• A GBS cutoff of 10 demonstrated low sensitivity (22.41%) for hemostatic interventions and moderate sensitivity (66.67%) for blood transfusion.

Conclusions:

• GBS has a clinical role in stratifying UGIB severity beyond a score of 2.
• The sensitivity of GBS cutoff at 10 is low for predicting interventions in UGIB.
• A more sensitive GBS cutoff is necessary for effective risk stratification of life-threatening UGIB.