Triage for upper gastrointestinal bleeding in the emergency department: a comparison of risk scoring systems

Risk classification and triage are important in predicting adverse clinical outcomes in patients with upper gastrointestinal bleeding (UGIB) presenting to the emergency department. The aim of our study was to compare classic risk scores (GBS and M-GBS) used in the literature with triage scores such as MAP(ASH), HARBINGER, and MTS in terms of major clinical outcomes.

This single-center retrospective study analyzed data from 593 patients who presented to the emergency department with suspected upper gastrointestinal bleeding and subsequently underwent endoscopy over a 5-year period. Clinical outcomes, including need for hospitalization, need for intensive care unit, need for endoscopic intervention, and in-hospital mortality, were evaluated.

The GBS, M-GBS, and MAP(ASH) scores were found to have superior performance in terms of the need for hospitalization. The MAP(ASH) score (AUC = 0.721) and the MTS (AUC = 0.694) were the best-performing scores in terms of the need for intensive care. The MAP(ASH) score had the highest AUC value in terms of the need for endoscopic intervention (AUC = 0.683). In predicting mortality, the MAP(ASH) score demonstrated good discriminative performance (AUC = 0.881). The MTS also showed good performance in predicting mortality (AUC = 0.820). In pairwise comparisons, neither the MAP(ASH) nor the MTS demonstrated superiority over the other in terms of mortality prediction (p > 0.05).

The MAP(ASH) score showed the highest or near-highest AUC values across evaluated clinical outcomes; however, no single risk score was clearly superior overall. Given the selected nature of the study population, these findings should be interpreted cautiously. Integration of risk scores with clinical judgment may improve the management of UGIB patients in the emergency department.