Performance of new thresholds of the Glasgow Blatchford score in managing patients with upper gastrointestinal bleeding

Laursen, S. B., Dalton, H. R., Murray, I. A., Michell, N., Johnston, M. R., Schultz, M., Hansen, J. M., Schaffalitzky de Muckadell, O. B., Blatchford, O. and Stanley, A. J. (2015) Performance of new thresholds of the Glasgow Blatchford score in managing patients with upper gastrointestinal bleeding. Clinical Gastroenterology and Hepatology, 13(1), 115-121.e2. (doi: 10.1016/j.cgh.2014.07.023) (PMID:25058843)

Abstract

Background & Aims: Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients’ risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could be managed as outpatients. Some investigators therefore have proposed extending the definition of low-risk patients by using a higher GBS cut-off value, possibly with an age adjustment. We compared 3 thresholds of the GBS and 2 age-adjusted modifications to identify the optimal cut-off value or modification. Methods: We performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients identified, and outcomes of patients classified as low risk. Results: There were differences in age (P = .0001), need for intervention (P < .0001), mortality (P < .015), and GBS (P = .0001) among sites. All systems identified low-risk patients with high levels of sensitivity (>97%). The GBS at cut-off values of ≤1 and ≤2, and both modifications, identified low-risk patients with higher levels of specificity (40%–49%) than the GBS with a cut-off value of 0 (22% specificity; P < .001). The GBS at a cut-off value of ≤2 had the highest specificity, but 3% of patients classified as low-risk patients had adverse outcomes. All GBS cut-off values, and score modifications, had low levels of specificity when tested in New Zealand (2.5%–11%). Conclusions: A GBS cut-off value of ≤1 and both GBS modifications identify almost twice as many low-risk patients with UGIH as a GBS at a cut-off value of 0. Implementing a protocol for outpatient management, based on one of these scores, could reduce hospital admissions by 15% to 20%.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Stanley, Dr Adrian and Blatchford, Dr Oli
• Authors: Laursen, S. B., Dalton, H. R., Murray, I. A., Michell, N., Johnston, M. R., Schultz, M., Hansen, J. M., Schaffalitzky de Muckadell, O. B., Blatchford, O., and Stanley, A. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Clinical Gastroenterology and Hepatology
• Publisher: Elsevier
• ISSN: 1542-3565
• ISSN (Online): 1542-7714
• Published Online: 21 July 2014