title: Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding.
abstract: BACKGROUND
  Data regarding the utility of the Glasgow-Blatchford bleeding score (GBS) in hospitalized patients with upper GI hemorrhage are limited.
  
  
  OBJECTIVE
  To evaluate the performance of the GBS in predicting clinical outcomes and the need for interventions in patients with upper GI hemorrhage.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Single, tertiary-care endoscopic center.
  
  
  METHODS
  Between July 2010 and July 2012, 888 consecutive hospitalized patients managed for upper GI hemorrhage were entered into the study.
  
  
  METHODS
  GBS and Rockall scores.
  
  
  METHODS
  GBS and Rockall scores were prospectively calculated. The performance of these scores to predict the need for interventions and outcomes was assessed by using a receiver operating characteristic curve.
  
  
  RESULTS
  Endoscopy was performed in 708 patients (80%). A total of 286 patients (40.3%) required endoscopic therapy, and 29 patients (3.8%) underwent surgery. GBS and post-endoscopy Rockall scores (post-E RS) were superior to pre-endoscopy Rockall scores in predicting the need for endoscopic therapy (area under the curve [AUC] 0.76 vs 0.76 vs 0.66, respectively) and rebleeding (AUC 0.71 vs 0.64 vs 0.57). The GBS was superior to Rockall scores in predicting the need for blood transfusion (AUC 0.81 vs 0.70 vs 0.68) and surgery (AUC 0.71 vs 0.64 vs 0.51). Patients with GBS scores ≤ 3 did not require intervention.
  
  
  CONCLUSIONS
  Subjective decision making as to need for endoscopic therapy and blood transfusion.
  
  
  CONCLUSIONS
  Compared with post-E RS, the GBS was superior in predicting the need for blood transfusion and surgery in hospitalized patients with upper GI hemorrhage and was equivalent in predicting the need for endoscopic therapy, rebleeding, and death. There are potential cutoff GBS scores that allow risk stratification for upper GI hemorrhage, which warrant further evaluation.
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Bryant
authors.forename: Paul
authors.initials: P
authors.lastname: Kuo
authors.forename: Kate
authors.initials: K
authors.lastname: Williamson
authors.forename: Chantelle
authors.initials: C
authors.lastname: Yam
authors.forename: Mark N
authors.initials: MN
authors.lastname: Schoeman
authors.forename: Richard H
authors.initials: RH
authors.lastname: Holloway
authors.forename: Nam Q
authors.initials: NQ
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D016888:Angiodysplasia / Q000175:diagnosis / Q000628:therapy; D019540:Area Under Curve; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000628:therapy; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D005773:Gastroscopy; D006760:Hospitalization; D006801:Humans; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013272:Stomach Diseases / Q000175:diagnosis* / Q000628:therapy; D062606:Tertiary Care Centers
keywords: AUC; GBS; Glasgow-Blatchford score; Pre-E RS; ROC; area under the curve; post-E RS; post-endoscopy Rockall score; pre-endoscopy Rockall score; receiver operating characteristic curve