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