title: Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department.
abstract: OBJECTIVE
  The Glasgow Blatchford Bleeding Score (GBS) has been developed to assess the need for treatment in patients with acute upper gastrointestinal hemorrhage (UGIH) presenting at emergency departments (EDs). We aimed (a) to determine the validity of the GBS and Rockall scoring systems for prediction of need for treatment and (b) to identify the optimal cut-off value of the GBS.
  
  
  METHODS
  We carried out a population-based, prospective multicenter study of 520 consecutive patients presenting with acute UGIH at EDs of three hospitals. The accuracy of GBS and Rockall scores in predicting the need for treatment (i.e. endoscopic, surgical, or radiological intervention and blood transfusion) was analyzed using receiver operating characteristic curves.
  
  
  RESULTS
  Receiver operating characteristic curve analysis showed that the GBS had a good discriminative ability to determine the need for treatment in patients with acute UGIH (area under the curve: 0.88; 95% confidence interval: 0.85-0.91). The GBS was superior to both the clinical Rockall and the full Rockall score in predicting the need for treatment (area under the curve: 0.86 vs. 0.70 vs. 0.77). At a cut-off value of up to 2, the GBS had the optimal combination of sensitivity (99.4%) and specificity (42.4%).
  
  
  CONCLUSIONS
  The GBS is superior compared with both Rockall scores in predicting the need for treatment in patients with suspected acute UGIH presenting at EDs in the Netherlands. Patients with a GBS of 2 or less form a subgroup of low-risk patients. These low-risk patients are eligible for outpatient management, which might reduce hospital admissions and healthcare costs.
authors.affiliation: aDepartment of Gastroenterology and Hepatology, Viecuri, Venlo bDepartment of Internal Medicine, Division of Gastroenterology and Hepatology cDepartment of Internal Medicine, Maastricht University Medical Center dNUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht eDepartment of Internal Medicine and Gastroenterology, Orbis Medical Center, Sittard-Geleen fDepartment of Internal Medicine and Gastroenterology, Atrium Medical Center, Heerlen, The Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Aquarius
authors.forename: Fabiënne G M
authors.initials: FG
authors.lastname: Smeets
authors.forename: Helena W
authors.initials: HW
authors.lastname: Konijn
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Stassen
authors.forename: Eric T
authors.initials: ET
authors.lastname: Keulen
authors.forename: Cees T
authors.initials: CT
authors.lastname: Van Deursen
authors.forename: Ad A M
authors.initials: AA
authors.lastname: Masclee
authors.forename: Yolande C
authors.initials: YC
authors.lastname: Keulemans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001803:Blood Transfusion; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010343:Patient Admission; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index