GBS scores for UGI bleeding

Identifying Low-Risk Upper GI Bleeds for Safe Outpatient Management
A simple scale can identify patients who do not require hospitalization or early endoscopy.
Most patients with upper gastrointestinal bleeding (UGIB) are hospitalized, although most do not die; rebleed; or require urgent endoscopic therapy, transfusion, or surgery. Researchers in Scotland investigated whether the previously published Glasgow-Blatchford bleeding score (GBS) was useful for prospectively identifying patients with UGIB (hematemesis, coffee-ground vomitus, or melena) who could be discharged home safely. Patients score "0" on the GBS if they have the following characteristics:

1. Hemoglobin level >12.9 g/dL (men) or >11.9 g/dL (women)
2. Systolic blood pressure >109 mm Hg
3. Pulse <100/minute>
4. Blood urea nitrogen level <18.2>
5. No melena or syncope
6. No past or present liver disease or heart failure

In phase 1 of this multicenter study (data collection), 16% of 630 consecutive outpatients who were evaluated for UGIB scored "0" on the GBS; all but 3 were admitted, and none died or required interventions. In phase 2 of the study (GBS-driven admissions), 572 consecutive outpatients with UGIB were evaluated; of 123 (22%) who scored "0" on the GBS, 84 were sent home with appointments for outpatient endoscopy. Twenty-three of these patients underwent their planned endoscopies (none of which led to interventions); among patients who missed their planned endoscopies, no hospital admissions or deaths had occurred at 6 months.

Comment:
When clinicians used GBS scores for guidance, the admission rate for patients with UGIB was reduced from 96% to 71%, with no adverse patient outcomes. If the GBS system is validated in other settings, it could prevent many unnecessary hospitalizations, which could improve patient safety and conserve resources.

—
Bruce Soloway, MD

Published in Journal Watch General Medicine January 20, 2009.
Citation(s): Stanley AJ et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: Multicentre validation and prospective evaluation. Lancet 2009 Jan 3; 373:42.