Stig B Laursen1, Harry R Dalton2, Iain A Murray3, Nick Michell2, Matt R Johnston4, Michael Schultz5, Jane M Hansen6, Ove B Schaffalitzky de Muckadell6, Oliver Blatchford7, Adrian J Stanley8. 1. Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark. Electronic address: stig.borbjerg.laursen@ouh.regionsyddanmark.dk. 2. Gastrointestinal Unit, Royal Cornwall Hospital, Cornwall, United Kingdom. 3. Gastrointestinal Unit, Dunedin Public Hospital, Dunedin, New Zealand. 4. Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. 5. Department of Medicine, University of Otago, Dunedin, New Zealand. 6. Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark. 7. Public Health Department, University of Glasgow, Glasgow, United Kingdom. 8. Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
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%.
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%.
Authors: Andrew J Palmer; Francesca Moroni; Sally Mcleish; Geraldine Campbell; Jonathan Bardgett; Joanna Round; Conor McMullan; Majid Rashid; Robert Clark; Dara De Las Heras; Claire Vincent Journal: Frontline Gastroenterol Date: 2015-06-05
Authors: Iain A Murray; Harry R Dalton; Adrian J Stanley; Jing H Ngu; Brian Maybin; Mahmoud Eid; Kenneth G Madsen; Rozeta Abazi; Hamad Ashraf; Mohamed Abdelrahim; Rebecca Lissmann; Jenny Herrod; Christopher Jl Khor; Hock S Ong; Doreen Sc Koay; Yung K Chin; Stig B Laursen Journal: United European Gastroenterol J Date: 2017-03-16 Impact factor: 4.623
Authors: Matthew R Johnston; Iain A Murray; Michael Schultz; Peter McLeod; Nathan O'Donnell; Heather Norton; Chelsea Baines; Emily Fawcett; Terry Fesaitu; Hin Leung; Jeong-Yoon Park; Adibah Salleh; Wei Zhang; José A García Journal: Gastroenterol Res Pract Date: 2015-05-18 Impact factor: 2.260
Authors: Alan N Barkun; Majid Almadi; Ernst J Kuipers; Loren Laine; Joseph Sung; Frances Tse; Grigorios I Leontiadis; Neena S Abraham; Xavier Calvet; Francis K L Chan; James Douketis; Robert Enns; Ian M Gralnek; Vipul Jairath; Dennis Jensen; James Lau; Gregory Y H Lip; Romaric Loffroy; Fauze Maluf-Filho; Andrew C Meltzer; Nageshwar Reddy; John R Saltzman; John K Marshall; Marc Bardou Journal: Ann Intern Med Date: 2019-10-22 Impact factor: 25.391