S661 Glasgow Blatchford Score for Triage of Gastrointestinal Bleeding in a Metropolitan ED

Abstract

Introduction: Gastrointestinal bleeding (GIB) is a common cause of hospitalization with a significant economic impact. Appropriate utilization of endoscopic resources could decrease costs. There are numerous risk stratifying tools that can aid in disposition for patients with upper GIB. The Glasgow Blatchford Score (GBS) is a validated scoring system that identifies patients who will require inpatient management. We aim to retrospectively assess the role of GBS in the triage of upper GIB at a metropolitan emergency department (ED). Methods: We performed a retrospective chart review examining management of suspected GI bleed over one year in an urban medical center. Patients with suspected GIB based on ICD-10 were recruited to the study. Clinical characteristics were collected and GBS was calculated at admission. Disposition and need for intervention were collected with primary endpoints of use of endoscopy, embolization, or surgery. Results: We examined 105 patients, 60 (57.1%) were male and 45 (42.9%) were female. Of these patients, 67 (63.8%) patients were admitted to general medicine floors, 8 (7.6%) patients required ICU admission, and 30 (28.6%) patients were admitted to the medicine telemetry/ICU-step down unit. Fifty-eight patients (56.3%) received blood transfusions. Seventy-four percent of the patients presented with melena. Ninety-two percent of the patients underwent endoscopy after admission; however, only 20 patients required hemostatic treatment. Five patients were admitted with GBS of 1 or less, three underwent endoscopy without hemostatic therapy while the other two did not. The length of stay for admitted patients ranged from 1 day to 20 days. None of the charts reviewed included patients who underwent a surgical procedure. Fifteen (14.3%) patients had hepatic disease and 42 (40.4%) patients had cardiac disease. Eleven patients (10.5%) were readmitted after intervention and discharge; 94 (89.5%) patients were not readmitted after discharge. Conclusion: GBS allows simple triage of patients and reliably identifies those requiring inpatient management. Most patients underwent an endoscopy and only one-fifth required endoscopic hemostatic therapy. Those admitted with GBS of 1 or less, did not require endoscopic hemostatic therapy and further validates its utility to decrease unnecessary healthcare utilization. While it is emerging as a promising tool, clinician awareness and acceptance deserve recognition.