J Korean Soc Emerg Med.  2014 Dec;25(6):645-652. 10.0000/jksem.2014.25.6.645.

Validation of the Glasgow-Blatchford score and the Pre-endoscopic Rockall Score for Predicting Active Gastrointestinal Bleeding in Emergency Department Patients with Suspected Upper Gastrointestinal Bleeding

• Lee DW
• Lee HS
• You JS
• Park YS
• Chung SP

• KMID: 2101240
• DOI: http://doi.org/10.0000/jksem.2014.25.6.645

Abstract

PURPOSE
The aim of this study was to validate the Glasgow-Blatchford score and the pre-endoscopic Rockall score to assess their ability to predict the presence of active bleeding in emergency department patients with suspected upper gastrointestinal bleeding.
METHODS
We reviewed and extracted data from electronic medical records on patients presenting with a suspicion of acute upper gastrointestinal bleeding at our emergency department from January 1, 2012 to December 31, 2012. For each patient we calculated the Glasgow-Blatchford score and the pre-endoscopic Rockall score. Discriminative ability of the scoring systems for predicting active bleeding was evaluated by receiver operator characteristic (ROC) curve analysis.
RESULTS
We identified 636 patients with upper gastrointestinal bleeding. There were 118 (18.6%) patients with active bleeding and 520 (81.8%) patients with need for intervention. The ROC curve analysis showed poor discriminative ability of the Glasgow-Blatchford score and the pre-endoscopic Rockall score for determining the presence of active bleeding (area under the curve (AUC)=0.546, 95% confidence interval (CI) 0.490-0.602 vs. 0.576, 95% CI 0.523-0.630; p=0.34). The sensitivity and the specificity of the two scoring systems were suboptimal. However, the Glasgow-Blatchford score outperformed the pre-endoscopic Rockall score in predicting the need for clinical intervention (AUC=0.867, 95% CI 0.831-0.903 vs. 0.698, 95% CI 0.643-0.754; p<0.001).
CONCLUSION
The Glasgow-Blatchford score was superior in predicting the need for intervention in emergency department patients with suspected gastrointestinal hemorrhage. However, these clinical decision rules may be insufficient to predict the presence of active bleeding.

Keyword

Upper gastrointestinal tract; Hemorrhage; Hemostasis

MeSH Terms

Electronic Health Records
Emergency Service, Hospital*
Gastrointestinal Hemorrhage
Hemorrhage*
Hemostasis
Humans
ROC Curve
Sensitivity and Specificity
Upper Gastrointestinal Tract