Comparing the Blatchford and pre-endoscopic Rockall score in predicting the need for endoscopic therapy in patients with upper GI hemorrhage.
BACKGROUND
The need for therapeutic endoscopy in patients with upper GI hemorrhage is important in determining the risk and disposition of these patients. Pre-endoscopic risk scores may be helpful in predicting this need.


OBJECTIVE
To test the Blatchford and pre-endoscopic Rockall scores with the need for therapeutic endoscopy as the primary outcome.


METHODS
Prospective validation study.


METHODS
Tertiary-care university-affiliated hospital.


METHODS
Between January 1, 2006 and February 28, 2007, 1087 patients with upper GI hemorrhage who had undergone an inpatient EGD within 24 hours were entered in the study.


METHODS
Blatchford and pre-endoscopic Rockall scores were prospectively calculated for all patients, and the need for therapeutic endoscopy was determined during the EGD.


RESULTS
Of the 1087 patients, 297 (27.3%) needed therapeutic endoscopy. The mean Blatchford score for those who needed therapeutic endoscopy was significantly higher (mean [standard deviation]: 10.3 [3.5] vs 7.0 [4.4], P < .001). The area under a receiver-operating characteristic curve was 0.72 (95% CI, 0.68-0.75). A threshold of 0 (low risk) predicted the need for therapeutic endoscopy with 100% sensitivity and 6.3% specificity. Fifty (4.6%) patients were identified as low risk. The pre-endoscopic Rockall score was unable to predict this need.


CONCLUSIONS
The decision to perform therapeutic endoscopy is a subjective one, although endoscopists are trained to follow international consensus guidelines.


CONCLUSIONS
The Blatchford score is more useful for predicting low-risk patients who do not need therapeutic endoscopy and who may be suitable for outpatient management. A threshold of 0 for low risk should be used. The Rockall score is not helpful in predicting the presence of low-risk lesions.
Pang
Sandy H
SH
Institute of Digestive Diseases, Chinese University of Hong Kong, Shatin NT, Hong Kong.
Ching
Jessica Y L
JY
Lau
James Y W
JY
Sung
Joseph J Y
JJ
Graham
David Y
DY
Chan
Francis K L
FK
D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index