Usefulness of the Glasgow Blatchford Score and Pre-Rockall Score as a tool for predicting the need for endoscopic treatment in vulnerable patients with upper gastrointestinal bleeding

Kang, Seong Jin; Lee, Yu Sung; Park, Hyun Kyung; Park, Keun Hong; Kim, Hahn Bom; Ham, Eun Mi; Park, Jin Hyung

J Korean Soc Emerg Med > Volume 32(3); 2021 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2021;32(3): 222-230.

상부위장관 출혈로 내원한 취약계층 환자에서 내시경 치료의 필요성을 예측하기 위한 도구로서의 Glasgow Blatchford Score, Pre-Rockall Score의 유용성

강성진

서울특별시 서울의료원 응급의학과

Usefulness of the Glasgow Blatchford Score and Pre-Rockall Score as a tool for predicting the need for endoscopic treatment in vulnerable patients with upper gastrointestinal bleeding

Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea

Correspondence

Yu Sung Lee ,Tel: 02-2276-7424, Fax: 02-2276-7418, Email: moock3588@naver.com,

Received: June 28, 2020; Revised: September 8, 2020 Accepted: September 15, 2020. Published online: June 30, 2021.

ABSTRACT

Objective:
Predictive tools such as the Glasgow Blatchford Score (GBS) and Pre-Rockall Score (PRS) have been used to foresee risks for gastrointestinal patients. This study was undertaken to determine the usefulness of the various available predictive tools in a vulnerable population.
Method:
Data of patients with vulnerable upper gastrointestinal bleeding, who visited the emergency room from January 1, 2017 to December 31, 2018, were retrospectively examined. The GBS and PRS values were determined for all patients. Predictions of therapeutic endoscopy were evaluated with the area under curve (AUC) in the receiver operatory characteristic (ROC) curve.
Results:
A total of 152 patients were included in the study, 46 of whom required therapeutic endoscopes. In the area below the ROC curve, higher GBS values were obtained as compared to PRS in predicting therapeutic endoscopy (AUC, 0.726; 95% confidence interval [CI], 0.648-0.795 vs. 0.705; 95% CI, 0.626-0.776; P=0.689, respectively), transfusion (AUC, 0.861; 95% CI, 0.796-0.912 vs. 0.715; 95% CI, 0.637-0.786; P=0.001, respectively), and 30-day mortality (AUC, 0.698; 95% CI, 0.618-0.770 vs. 0.622; 95% CI, 0.540-0.699; P=0.351, respectively). Considering GBS 0, we determined with 100% sensitivity and 4.72% specificity that endoscopic treatment is redundant.
Conclusion:
Compared to PRS, GBS excelled in predicting interventional treatment (endoscopy, transfusion) of vulnerable upper gastrointestinal patients, as well as the 30-day mortality. GBS is more useful in predicting low-risk patients that do not require treatment endoscopy, and is therefore a suitable procedure for outpatient care.

Key words: Vulnerable population; Gastrointestinal hemorrhage