title: Validity of modified early warning, Glasgow Blatchford, and pre-endoscopic Rockall scores in predicting prognosis of patients presenting to emergency department with upper gastrointestinal bleeding.
abstract: BACKGROUND
  GBS, MEWS, and PER scoring systems are not commonly used for patients presenting to emergency department with GIS bleeding. This study aimed to determine the value of MEWS, GBS, and PER scores in predicting bleeding at follow-up, endoscopic therapy and blood transfusion need, mortality, and rebleeding within a 1-month period.
  
  
  METHODS
  A total of 202 consecutive patients with upper GIS bleeding between July 2013 and November 2014 were prospectively enrolled in the study. The relationship between MEWS, GBS, and PER scores and hospital outcome, bleeding at follow-up, endoscopic therapy, transfusion need, rebleeding, and death were examined.
  
  
  RESULTS
  The study included a total of 202 subjects, with 84 (41.6 %) females and 118 (58.4 %) males. There was a significant correlation between GBS, MEWS, and PER scores and hospital outcomes (p <0.004, p <0.001, p <0.001, respectively). A GBS score greater than 11 succesfully predicted bleeding at follow-up (p = 0.0237). GBS score's sensitivity for predicting endoscopic therapy was greater than those of other scoring systems. The discriminatory power of each scoring system was significant for predicting transfusion (p <0.0001, p = 0.0470, and p = 0.0014, respectively). A GBS score greater than 13, a MEWS score greater than 2, and a PER score greater than 3 predicted death. A PER score greater than 3 predicted rebleeding (p <0.0001).
  
  
  CONCLUSIONS
  The scoring systems in question can be easily calculated in patients presenting to ED with upper GIS bleeding and may be beneficial for risk stratification, determination of transfusion need, prediction of rebleeding, and decisions of hospitalization or discharge.
authors.affiliation: Emergency Medicine Department, Mersin University Medical Faculty, Mersin, Turkey. seyranbozkurt@gmail.com.
authors.forename: Seyran
authors.initials: S
authors.lastname: Bozkurt
authors.affiliation: Emergency Medicine Department, Mersin University Medical Faculty, Mersin, Turkey.
authors.forename: Ataman
authors.initials: A
authors.lastname: Köse
authors.affiliation: Department of Emergency Medicine, Diskapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey.
authors.forename: Engin Deniz
authors.initials: ED
authors.lastname: Arslan
authors.affiliation: Biostatistics and Medical Informatics Department, Mersin University Medical Faculty, Mersin, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Erdoğan
authors.affiliation: Gastroenterology Department, Mersin University Medical Faculty, Mersin, Turkey.
authors.forename: Enver
authors.initials: E
authors.lastname: Üçbilek
authors.affiliation: Emergency Medicine Department, Mersin University Medical Faculty, Mersin, Turkey.
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Çevik
authors.affiliation: Emergency Medicine Department, Mersin University Medical Faculty, Mersin, Turkey.
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Ayrık
authors.affiliation: Gastroenterology Department, Mersin University Medical Faculty, Mersin, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Sezgin
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001803:Blood Transfusion / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D018450:Disease Progression; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005773:Gastroscopy / Q000379:methods; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate