“Low Risk” Blatchford and AIMS65 Scores Do Not Identify Patients Who Can Be Discharged from the Emergency Department

Abstract

Purpose: To assess if AIMS65 and Blatchford scores can identify patients presenting to the Emergency Department (ED) with “low risk” upper GI bleeding, defined as a Blatchford score ≤2 or AIMS65=0, who could be discharged. Methods: Retrospective chart review (October 2009-September 2012) of patients presenting to the ED with upper GI bleeding, who were admitted and underwent esophagogastroduodenoscopy (EGD). Charts were reviewed for demographics, pertinent data necessary to calculate Blatchford and AIMS65 scores retrospectively. Outcomes were recorded including endoscopy findings, need for intervention, need for blood transfusion, Intensive Care Unit (ICU) admission, mortality, inpatient and 30-day rebleeding, and length of stay. Patients with cirrhosis, lower GI bleeding, or occult bleeding were excluded. Results: 220 patients were identified. 112 (51%) patients were male. Mean age was 65 years old (Range 19-96). 72 (33%) patients were taking anticoagulants. The most common endoscopic finding was PUD (29.1%). 51 patients (23.2%) required endoscopic intervention. 20 patients (9.1%) had inpatient rebleeding and 32 (14.1%) had rebleeding within 30 days. 109 patients (49.5%) were admitted to ICU. 160 patients (72.7%) received a blood transfusion. Five patients (2.3%) died during hospitalization. The mean length of stay was 6.65 days (median 5). The mean Blatchford score was 9.38 (Range 0-18). The Blatchford score was significantly associated with the significant EGD findings (p=0.03), inpatient rebleeding (p=.01), ICU admission (p=0.00), and need for transfusion (p=0.00). 24 patients (10.9%) had a “low risk” Blatchford score. Although there were no deaths in this group, 4 (16.7%) required endoscopic therapy, 5 (20.8%) were admitted to the ICU, 2 (8.3%) received a blood transfusion, and 4 (16.7%) were readmitted within 30 days for rebleeding. The mean AIMS65 score was 1.29 (Range 0-4). The AIMS65 was significantly associated with inpatient rebleeding (p=0.04), ICU admission (p=0.00), mortality (p=0.02), and need for transfusion (p=0.00). 58 patients (26%) had a “low risk” AIMS65 score. No “low risk” patients died. However, 13 of these patients (22.4%) had endoscopic intervention, 14 (24.1%) were admitted to the ICU, 28 (48.3%) received a blood transfusion, and 5 (8.3%) were rebled within 30 days. Conclusion: Although the Blatchford score and AIMS65 score correlate with several clinically significant outcomes, “low risk” Blatchford or AIMS65 scores could not accurately identify those patients who could be discharged from the ED, as a significant proportion of patients required endoscopic intervention, blood transfusion, ICU admission, or had rebleeding within 30 days.