title: Is the Glasgow Blatchford score useful in the risk assessment of patients presenting with variceal haemorrhage?
abstract: BACKGROUND
  The Glasgow Blatchford score (GBS) is a pre-endoscopic risk assessment tool for patients presenting with upper gastrointestinal haemorrhage. There are few data regarding use in patients with variceal bleeding, who are generally accepted as being at high risk.
  
  
  OBJECTIVE
  The aim of the study was to assess GBS in correctly identifying patients with subsequently proven variceal bleeding as 'high risk' and to compare GBS, admission and full Rockall scores in predicting clinical endpoints in this group.
  
  
  METHODS
  Data on consecutive patients with upper gastrointestinal haemorrhage presenting to four UK hospitals were collected. The GBS, admission and full Rockall scores were calculated and compared for the subgroup subsequently shown to have variceal bleeding. Area under the receiver operating curve (AUROC) was used to assess the scores ability to predict clinical endpoints within this variceal bleeding subgroup.
  
  
  RESULTS
  A total of 1432 patients presented during the study period. Seventy-one (5%) had a final diagnosis of variceal bleeding. At presentation, none of this group had GBS less than 2, but six had an admission Rockall score of 0. In predicting need for blood transfusion, AUROC scores for GBS, full and admission Rockall scores were 0.68, 0.65 and 0.68, respectively. For endoscopic/surgical intervention the scores were 0.34, 0.51 and 0.55, respectively, and for predicting death the scores were 0.56, 0.72 and 0.70, respectively. None of these AUROC score comparisons were significant.
  
  
  CONCLUSIONS
  At presentation, GBS correctly identifies patients with variceal bleeding as high risk and appears superior to the admission Rockall score. However, GBS and both Rockall scores are poor at predicting clinical outcome within this group.
authors.affiliation: aGI Unit, Glasgow Royal Infirmary bHealth Protection Scotland, Glasgow cGastroenterology Department, Ninewells Hospital, Dundee, Scotland dGastroenterology Department, Royal Cornwall Hospital, Truro, Cornwall eGastroenterology Department, North Tees University Hospital, Stockton-on-Tees, Cleveland, UK.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Reed
authors.forename: Harry
authors.initials: H
authors.lastname: Dalton
authors.forename: Oliver
authors.initials: O
authors.lastname: Blatchford
authors.forename: Dawn
authors.initials: D
authors.lastname: Ashley
authors.forename: Craig
authors.initials: C
authors.lastname: Mowat
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Gaya
authors.forename: Aiden
authors.initials: A
authors.lastname: Cahill
authors.forename: Ursula
authors.initials: U
authors.lastname: Warshow
authors.forename: Nicola
authors.initials: N
authors.lastname: Hare
authors.forename: Maximillion
authors.initials: M
authors.lastname: Groome
authors.forename: Ewan H
authors.initials: EH
authors.lastname: Forrest
authors.forename: John
authors.initials: J
authors.lastname: Morris
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Stanley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001803:Blood Transfusion; D003661:Decision Support Techniques; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D006113:United Kingdom