J Korean Soc Emerg Med.  2015 Feb;26(1):21-28. 10.0000/jksem.2015.26.1.21.

Appropriateness of Glasgow-Blatchford Scoring System in Early Prediction of High Risk Group for Old Age Upper Gastrointestinal Bleeding Patients Visiting Emergency Department

• Park KH
• Lee CJ
• Chun JM
• Bae JK
• Je SM
• Chung TN
• Kim EC
• Choi SW
• Kim OJ

• KMID: 2191830
• DOI: http://doi.org/10.0000/jksem.2015.26.1.21

Abstract

PURPOSE
Upper gastrointestinal bleeding (UGIB) is one of the most common causes of emergency department (ED) presentation which can lead to a fatal condition. Many clinical scoring systems intended to predict the prognosis of UGIB patients were developed and validated, including Glasgow-Blatchford score (GBS) and Rockall score (RS). In particular, GBS has shown its superiority in prediction of mortality, the necessity of endoscopic intervention and admission, compared with other scoring systems, in recent studies. However, GBS does not include the age of the patient as its component and has clearly shown its efficacy only in subjects under age 70. Hence, we aimed to assess whether GBS could also be used in old age UGIB patients as a useful risk stratifying method as in younger age.
METHODS
UGIB patients who visited our ED for one year were retrospectively enrolled in the analysis. Medical records of the subjects were reviewed, and their GBS and clinical RS were calculated. Receiver-operating characteristics (ROC) curve of each score in prediction of high risk UGIB was drawn and area under curve (AUC) was calculated. Correlation analysis of each score and hospital length of stay was also performed. To assess the validity of each score for use in old age patients, all analyses were also performed in subgroups of age over 60 years, and under that.
RESULTS
ROC curves suggest that GBS has significant detecting power for high risk UGIB in overall subjects, subgroups of age over 60 and under (p=<0.001 for all, AUC=0.919, 0.935, 0.901, respectively). Otherwise, clinical RS only showed significant results in overall group and subgroup of age over 60 with lower AUC.
CONCLUSION
GBS may also be used safely as an initial risk stratifying method in old age UGIB patients visiting the ED, as in other age groups.

Keyword

Gastrointestinal hemorrhage; Patient acuity; Geriatric assessment

MeSH Terms

Area Under Curve
Emergency Service, Hospital*
Gastrointestinal Hemorrhage
Geriatric Assessment
Hemorrhage*
Humans
Length of Stay
Medical Records
Mortality
Patient Acuity
Prognosis
Retrospective Studies
ROC Curve