Upper gastrointestinal bleeding risk stratification: Difference between revisions
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{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Two scoring systems identify those at risk for [[adverse outcomes]] from UGIB which include Glasgow Blatchford Score (GBS) and Rockall score. Glasgow Blatchford score is most commonly used and is more accurate. | |||
==Risk stratification== | ==Risk stratification== | ||
Two scoring systems identify those at risk for adverse outcomes from UGIB:<ref name="pmid28286843">{{cite journal |vauthors=Ebrahimi Bakhtavar H, Morteza Bagi HR, Rahmani F, Shahsavari Nia K, Ettehadi A |title=Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review |journal=Emerg (Tehran) |volume=5 |issue=1 |pages=e36 |year=2017 |pmid=28286843 |pmc=5325906 |doi= |url=}}</ref> | Two scoring systems identify those at risk for adverse outcomes from UGIB:<ref name="pmid28286843">{{cite journal |vauthors=Ebrahimi Bakhtavar H, Morteza Bagi HR, Rahmani F, Shahsavari Nia K, Ettehadi A |title=Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review |journal=Emerg (Tehran) |volume=5 |issue=1 |pages=e36 |year=2017 |pmid=28286843 |pmc=5325906 |doi= |url=}}</ref> | ||
| Line 8: | Line 10: | ||
*The Rockall score | *The Rockall score | ||
==The Glasgow Blatchford Score (GBS)== | ==The Glasgow Blatchford Score (GBS)== | ||
*The Glasgow Blatchford Score (GBS) helps in identifying low-risk patients with UGIB who can be managed safely as outpatients without an urgent endoscopy.<ref name="pmid11073021">{{cite journal |vauthors=Blatchford O, Murray WR, Blatchford M |title=A risk score to predict need for treatment for upper-gastrointestinal haemorrhage |journal=Lancet |volume=356 |issue=9238 |pages=1318–21 |year=2000 |pmid=11073021 |doi=10.1016/S0140-6736(00)02816-6 |url=}}</ref><ref name="pmid22719181">{{cite journal |vauthors=Stanley AJ |title=Update on risk scoring systems for patients with upper gastrointestinal haemorrhage |journal=World J. Gastroenterol. |volume=18 |issue=22 |pages=2739–44 |year=2012 |pmid=22719181 |pmc=3374976 |doi=10.3748/wjg.v18.i22.2739 |url=}}</ref> | *The Glasgow Blatchford Score (GBS) helps in identifying low-risk patients with UGIB who can be managed safely as [[outpatients]] without an urgent [[endoscopy]].<ref name="pmid11073021">{{cite journal |vauthors=Blatchford O, Murray WR, Blatchford M |title=A risk score to predict need for treatment for upper-gastrointestinal haemorrhage |journal=Lancet |volume=356 |issue=9238 |pages=1318–21 |year=2000 |pmid=11073021 |doi=10.1016/S0140-6736(00)02816-6 |url=}}</ref><ref name="pmid22719181">{{cite journal |vauthors=Stanley AJ |title=Update on risk scoring systems for patients with upper gastrointestinal haemorrhage |journal=World J. Gastroenterol. |volume=18 |issue=22 |pages=2739–44 |year=2012 |pmid=22719181 |pmc=3374976 |doi=10.3748/wjg.v18.i22.2739 |url=}}</ref> | ||
*GBS parameters include | *GBS parameters include: | ||
**Blood urea nitrogen level | **[[Blood urea nitrogen|Blood urea nitrogen level]] | ||
**Hematocrit level | **[[Hematocrit]] level | ||
**Heart rate | **[[Heart rate]] | ||
**Systolic blood pressure | **[[Blood pressure|Systolic blood pressure]] | ||
**Presence of syncope or melena, as well as presence of comorbid heart and liver disease | **Presence of [[syncope]] or [[melena]], as well as presence of [[Comorbidities|comorbid]] [[heart]] and [[Liver diseases|liver disease]] | ||
GBS is the more effective system for predicting the need for [[Blood transfusion|transfusion]] in patients with UGIB: | |||
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable" | {| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable" | ||
! colspan="4" style="background:#efefef;" |The Glasgow Blatchford Score (GBS) | ! colspan="4" style="background:#efefef;" |The Glasgow Blatchford Score (GBS) | ||
| Line 22: | Line 24: | ||
! style="background:#efefef;" |'''Score''' | ! style="background:#efefef;" |'''Score''' | ||
|- | |- | ||
| colspan="2" rowspan="4" |'''Blood urea nitrogen level (mg/dl)''' | | colspan="2" rowspan="4" |'''[[Blood urea nitrogen|Blood urea nitrogen level]] (mg/dl)''' | ||
| ≥ 18.2 to < 22.4 | | ≥ 18.2 to < 22.4 | ||
|2 | |2 | ||
| Line 35: | Line 37: | ||
|6 | |6 | ||
|- | |- | ||
| rowspan="5" |'''Hemoglobin level (g/dl)''' | | rowspan="5" |'''[[Hemoglobin]] level (g/dl)''' | ||
| rowspan="3" |'''Men''' | | rowspan="3" |'''Men''' | ||
| ≥ 12 to < 13 | | ≥ 12 to < 13 | ||
| Line 53: | Line 55: | ||
|6 | |6 | ||
|- | |- | ||
| colspan="2" rowspan="3" |'''Systolic blood pressure (mmHg)''' | | colspan="2" rowspan="3" |'''[[Systolic blood pressure]] (mmHg)''' | ||
| ≥ 100 to < 109 | | ≥ 100 to < 109 | ||
|1 | |1 | ||
| Line 64: | Line 66: | ||
|- | |- | ||
| colspan="2" rowspan="5" |'''Other markers''' | | colspan="2" rowspan="5" |'''Other markers''' | ||
|Pulse rate ≥ 100 beats/min | |[[Pulse rate]] ≥ 100 beats/min | ||
|1 | |1 | ||
|- | |- | ||
|Presentation with melena | |Presentation with [[melena]] | ||
|1 | |1 | ||
|- | |- | ||
|Presentation with syncope | |Presentation with [[syncope]] | ||
|2 | |2 | ||
|- | |- | ||
|Hepatic disease | |[[Hepato-biliary diseases|Hepatic disease]] | ||
|2 | |2 | ||
|- | |- | ||
|Heart failure | |[[Heart failure]] | ||
|2 | |2 | ||
|- | |- | ||
| rowspan="2" |Interpratation of score | | rowspan="2" |'''Interpratation of score''' | ||
|0-2 | |0-2 | ||
| colspan="2" |Low-risk group | | colspan="2" |Low-risk group | ||
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===The Rockall score=== | ===The Rockall score=== | ||
The complete Rockall score identifies those patients with evidence of acute UGIB on [[endoscopy]] who are at low risk for further [[bleeding]] or death.<ref name="pmid">{{cite journal |vauthors=Monteiro S, Gonçalves TC, Magalhães J, Cotter J |title=Upper gastrointestinal bleeding risk scores: Who, when and why? |journal=World J Gastrointest Pathophysiol |volume=7 |issue=1 |pages=86–96 |year=2016 |pmid= |pmc=4753192 |doi=10.4291/wjgp.v7.i1.86 |url=}}</ref><ref name="pmid18346681">{{cite journal |vauthors=Atkinson RJ, Hurlstone DP |title=Usefulness of prognostic indices in upper gastrointestinal bleeding |journal=Best Pract Res Clin Gastroenterol |volume=22 |issue=2 |pages=233–42 |year=2008 |pmid=18346681 |doi=10.1016/j.bpg.2007.11.004 |url=}}</ref> | |||
*The score is based upon | *The score is based upon: | ||
**Age | **[[Age]] | ||
**Presence of shock | **Presence of [[shock]] | ||
**Comorbidity diagnosis | **[[Comorbidity|Comorbidity diagnosis]] | ||
**Endoscopic ulcer characteristics | **[[Endoscopy|Endoscopic]] [[ulcer]] characteristics | ||
**Stigmata of recent hemorrhage | **Stigmata of [[Hemorrhage|recent hemorrhage]] | ||
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable" | {| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable" | ||
! colspan="4" style="background:#efefef;" |The Rockall score | ! colspan="4" style="background:#efefef;" |The Rockall score | ||
| Line 112: | Line 114: | ||
|- | |- | ||
| rowspan="5" |'''Shock stage''' | | rowspan="5" |'''Shock stage''' | ||
| rowspan="3" |Blood pressure | | rowspan="3" |[[Blood pressure]] | ||
|>120 | |>120 | ||
|0 | |0 | ||
| Line 122: | Line 124: | ||
|2 | |2 | ||
|- | |- | ||
| rowspan="2" |Heart rate | | rowspan="2" |[[Heart rate]] | ||
|>100 | |>100 | ||
|0 | |0 | ||
| Line 133: | Line 135: | ||
|0 | |0 | ||
|- | |- | ||
|Cardiac failure | |[[Cardiac failure]] | ||
Ischemic heart disease | [[Ischemic heart disease]] | ||
Any major comorbidity | Any major [[comorbidity]] | ||
|2 | |2 | ||
|- | |- | ||
|Renal failure | |[[Renal failure]] | ||
Liver failure | [[Liver failure]] | ||
Disseminated malignancy | Disseminated [[malignancy]] | ||
|3 | |3 | ||
|- | |- | ||
| colspan="2" rowspan="3" |'''Diagnosis''' | | colspan="2" rowspan="3" |'''Diagnosis''' | ||
|Mallory-Weiss tear, no lesion identified and no SRH | |[[Mallory-Weiss syndrome|Mallory-Weiss tear]], no lesion identified and no SRH | ||
|0 | |0 | ||
|- | |- | ||
| Line 152: | Line 154: | ||
|1 | |1 | ||
|- | |- | ||
|Malignancy of upper GI tract | |[[Malignancy]] of upper GI tract | ||
|2 | |2 | ||
|- | |- | ||
| Line 159: | Line 161: | ||
|0 | |0 | ||
|- | |- | ||
|Blood in upper GI tract, adherent clot,<br> visible or spurting vessel | |Blood in upper [[GI tract]], adherent clot,<br> visible or spurting vessel | ||
|2 | |2 | ||
|- | |- | ||
| | | rowspan="2" |'''Interpratation of score''' | ||
(Range of score is 0-11) | |||
Range of score is 0-11 | |Score of ≤ 3 | ||
| colspan="2" |Low mortality risk | |||
Score of ≤ 3 | |- | ||
|Score of ≥ 8 | |||
| colspan="2" |High mortality risk | |||
|- | |||
| colspan="4" |GI: Gastrointestinal, SRH: Signs of recent [[hemorrhage]] | |||
|} | |} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 15:08, 5 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Two scoring systems identify those at risk for adverse outcomes from UGIB which include Glasgow Blatchford Score (GBS) and Rockall score. Glasgow Blatchford score is most commonly used and is more accurate.
Risk stratification
Two scoring systems identify those at risk for adverse outcomes from UGIB:[1]
- The Glasgow Blatchford Score (GBS)
- The Rockall score
The Glasgow Blatchford Score (GBS)
- The Glasgow Blatchford Score (GBS) helps in identifying low-risk patients with UGIB who can be managed safely as outpatients without an urgent endoscopy.[2][3]
- GBS parameters include:
- Blood urea nitrogen level
- Hematocrit level
- Heart rate
- Systolic blood pressure
- Presence of syncope or melena, as well as presence of comorbid heart and liver disease
GBS is the more effective system for predicting the need for transfusion in patients with UGIB:
| The Glasgow Blatchford Score (GBS) | |||
|---|---|---|---|
| Admission risk markers | Score | ||
| Blood urea nitrogen level (mg/dl) | ≥ 18.2 to < 22.4 | 2 | |
| ≥ 22.4 to < 28 | 3 | ||
| ≥ 28 to < 70 | 4 | ||
| ≥ 70 | 6 | ||
| Hemoglobin level (g/dl) | Men | ≥ 12 to < 13 | 1 |
| ≥ 10 to < 12 | 3 | ||
| < 10 | 6 | ||
| Women | ≥ 10 to < 12 | 1 | |
| < 10 | 6 | ||
| Systolic blood pressure (mmHg) | ≥ 100 to < 109 | 1 | |
| ≥ 90 to < 99 | 2 | ||
| < 90 | 3 | ||
| Other markers | Pulse rate ≥ 100 beats/min | 1 | |
| Presentation with melena | 1 | ||
| Presentation with syncope | 2 | ||
| Hepatic disease | 2 | ||
| Heart failure | 2 | ||
| Interpratation of score | 0-2 | Low-risk group | |
| >6 | High risk group | ||
The Rockall score
The complete Rockall score identifies those patients with evidence of acute UGIB on endoscopy who are at low risk for further bleeding or death.[4][5]
- The score is based upon:
- Age
- Presence of shock
- Comorbidity diagnosis
- Endoscopic ulcer characteristics
- Stigmata of recent hemorrhage
| The Rockall score | |||
|---|---|---|---|
| Markers | Score | ||
| Age | <60 | 0 | |
| 60 - 79 | 1 | ||
| ≥ 80 | 2 | ||
| Shock stage | Blood pressure | >120 | 0 |
| 100-119 | 1 | ||
| <100 | 2 | ||
| Heart rate | >100 | 0 | |
| <100 | 1 | ||
| Comorbidity | No major comorbidity | 0 | |
| Cardiac failure
Any major comorbidity |
2 | ||
| Renal failure
Disseminated malignancy |
3 | ||
| Diagnosis | Mallory-Weiss tear, no lesion identified and no SRH | 0 | |
| All other diagnosis | 1 | ||
| Malignancy of upper GI tract | 2 | ||
| Major SRH | None or dark spot only | 0 | |
| Blood in upper GI tract, adherent clot, visible or spurting vessel |
2 | ||
| Interpratation of score
(Range of score is 0-11) |
Score of ≤ 3 | Low mortality risk | |
| Score of ≥ 8 | High mortality risk | ||
| GI: Gastrointestinal, SRH: Signs of recent hemorrhage | |||
References
- ↑ Ebrahimi Bakhtavar H, Morteza Bagi HR, Rahmani F, Shahsavari Nia K, Ettehadi A (2017). "Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review". Emerg (Tehran). 5 (1): e36. PMC 5325906. PMID 28286843.
- ↑ Blatchford O, Murray WR, Blatchford M (2000). "A risk score to predict need for treatment for upper-gastrointestinal haemorrhage". Lancet. 356 (9238): 1318–21. doi:10.1016/S0140-6736(00)02816-6. PMID 11073021.
- ↑ Stanley AJ (2012). "Update on risk scoring systems for patients with upper gastrointestinal haemorrhage". World J. Gastroenterol. 18 (22): 2739–44. doi:10.3748/wjg.v18.i22.2739. PMC 3374976. PMID 22719181.
- ↑ Monteiro S, Gonçalves TC, Magalhães J, Cotter J (2016). "Upper gastrointestinal bleeding risk scores: Who, when and why?". World J Gastrointest Pathophysiol. 7 (1): 86–96. doi:10.4291/wjgp.v7.i1.86. PMC 4753192.
- ↑ Atkinson RJ, Hurlstone DP (2008). "Usefulness of prognostic indices in upper gastrointestinal bleeding". Best Pract Res Clin Gastroenterol. 22 (2): 233–42. doi:10.1016/j.bpg.2007.11.004. PMID 18346681.