Full Rockall Score Research Articles

OC-017 International Multicentre Study Assessing the Effects of Anti-Thrombotic Use in Patients with Upper GI Bleeding

Introduction Anti-thrombotics (antiplatelets and anticoagulants; ATs) have been identified as risk factors for upper gastrointestinal bleeding (UGIB). However few international studies have evaluated their effect on patient outcome. We aimed to assess the effects of AT use on outcome in patients with high-risk UGIB requiring endoscopic therapy. Methods Patients presenting with UGIB who required endoscopic therapy at eight centres (Scotland, England, USA, Canada, Denmark, Italy, Singapore & New Zealand) were prospectively included over 12 months. Data recorded included the full Rockall score (FRS); AT use (Aspirin, Adenosine Diphosphate Receptor Inhibitors (ADP-RI), Vitamin-K Antagonists (VKA), Low Molecular Weight Heparin (LMWH), Thrombin inhibitors and Factor Xa inhibitors); endoscopic findings; blood transfusion; interventional radiology; surgery; rebleeding; 30 day mortality and length of hospital stay. Results Out of 3154 patients, 619 required endotherapy (44% for ulcer bleeding and 21% for varices). 187 (30%) patients were on aspirin, 61 (11%) ADP-RI, 57 (9%) VKA, 8 (1%) LMWH, 7 (1%) factor Xa-inhibitor and 1 patient a thrombin-inhibitor. 63 (11%) patients were treated with >1 type of AT. Patients treated with ATs were older (p Conclusion Patients with UGIB who require endoscopic therapy whilst on ATs do not experience a higher rate of rebleeding or mortality compared with UGIB patients who do not use ATs. We observed excess mortality in patients not taking ATs, which is likely due to the high rates of cirrhosis (40%) and variceal bleeding (33%) in these patients. Further studies are needed to clarify the risk of adverse outcome following UGIB in patients taking novel ATs. Disclosure of Interest None Declared

Outcome of acute upper gastrointestinal bleeding in patients with coronary artery disease: A matched case-control study.

Background/Aim:The risk of upper gastrointestinal bleeding (UGIB) increases in patients with coronary artery disease (CAD) due to the frequent use of antiplatelets. There is some data reporting on treatment outcomes in CAD patients presenting with UGIB. We aim to determine the clinical characteristics and outcomes of UGIB in patients with CAD, compared with non-CAD patients.Patients and Methods:We conducted a prospective multi-center cohort study (THAI UGIB-2010) that enrolled 981 consecutive hospitalized patients with acute UGIB. A matched case–control analysis using this database, which was collected from 11 tertiary referral hospitals in Thailand between January 2010 and September 2011, was performed.Result:Of 981 hospitalized patients with UGIB, there were 61 CAD patients and 244 gender-matched non-CAD patients (ratio 1:4). UGIB patients with CAD were significantly older, and had more frequently used antiplatelets and warfarin than in non-CAD patients. Compared with non-CAD, the CAD patients had significantly higher Glasgow–Blatchford score, full and pre-endoscopic Rockall score and full. Peptic ulcer in CAD patients was identified more often than in non-CAD patients. UGIB patients with CAD and non-CAD had similar outcomes with regard to mortality rate, re-bleeding, surgery, embolization, and packed erythrocyte transfusion. However, CAD patients had longer duration of hospital stays than non-CAD patients. Two CAD patients died from cardiac arrest after endoscopy, whereas three non-CAD patients died from pneumonia and acute renal failure during their hospitalization.Conclusion:In Thailand, patients presenting with UGIB, concomitant CAD did not affect clinical outcome of treatment, compared with non-CAD patients, except for longer hospital stay.

Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems

The American College of Gastroenterology recommends early risk stratification in patients presenting with upper GI bleeding (UGIB). The AIMS65 score is a risk stratification score previously validated to predict inpatient mortality. The aim of this study was to validate the AIMS65 score as a predictor of inpatient mortality in patients with acute UGIB and to compare it with established pre- and postendoscopy risk scores. ICD-10 (International Classification of Diseases, Tenth Revision) codes identified patients presenting with UGIB requiring endoscopy. All patients were risk stratified by using the AIMS65, Glasgow-Blatchford score (GBS), pre-endoscopy Rockall, and full Rockall scores. The primary outcome was inpatient mortality. Secondary outcomes were a composite endpoint of inpatient mortality, rebleeding, and endoscopic, radiologic, or surgical intervention; blood transfusion requirement; intensive care unit (ICU) admission; rebleeding; and hospital length of stay. The area under the receiver-operating characteristic curve (AUROC) was calculated for each score. Of the 424 study patients, 18 (4.2%) died and 69 (16%) achieved the composite endpoint. The AIMS65 score was superior to both the GBS (AUROC, 0.80 vs 0.76, P< .027) and the pre-endoscopy Rockall score (0.74, P= .001) and equivalent to the full Rockall score (0.78, P= .18) in predicting inpatient mortality. The AIMS65 score was superior to all other scores in predicting the need for ICU admission and length of hospital stay. AIMS65, GBS, and full Rockall scores were equivalent (AUROCs, 0.63 vs 0.62 vs 0.63, respectively) and superior to pre-endoscopy Rockall (AUROC, 0.55) in predicting the composite endpoint. GBS was superior to all other scores for predicting blood transfusion. The AIMS65 score is a simple risk stratification score for UGIB with accuracy superior to that of GBS and pre-endoscopy Rockall scores in predicting in-hospital mortality and the need for ICU admission.

Prospective multicenter validation of the Glasgow Blatchford bleeding score in the management of patients with upper gastrointestinal hemorrhage presenting at an emergency department

The Glasgow Blatchford Bleeding Score (GBS) has been developed to assess the need for treatment in patients with acute upper gastrointestinal hemorrhage (UGIH) presenting at emergency departments (EDs). We aimed (a) to determine the validity of the GBS and Rockall scoring systems for prediction of need for treatment and (b) to identify the optimal cut-off value of the GBS. We carried out a population-based, prospective multicenter study of 520 consecutive patients presenting with acute UGIH at EDs of three hospitals. The accuracy of GBS and Rockall scores in predicting the need for treatment (i.e. endoscopic, surgical, or radiological intervention and blood transfusion) was analyzed using receiver operating characteristic curves. Receiver operating characteristic curve analysis showed that the GBS had a good discriminative ability to determine the need for treatment in patients with acute UGIH (area under the curve: 0.88; 95% confidence interval: 0.85-0.91). The GBS was superior to both the clinical Rockall and the full Rockall score in predicting the need for treatment (area under the curve: 0.86 vs. 0.70 vs. 0.77). At a cut-off value of up to 2, the GBS had the optimal combination of sensitivity (99.4%) and specificity (42.4%). The GBS is superior compared with both Rockall scores in predicting the need for treatment in patients with suspected acute UGIH presenting at EDs in the Netherlands. Patients with a GBS of 2 or less form a subgroup of low-risk patients. These low-risk patients are eligible for outpatient management, which might reduce hospital admissions and healthcare costs.

796 Role of ARX in Enteroendocrine Development and Lipid Absorption

G A A b st ra ct s analysis, a Pre-Rockall score ≥4 (OR=4.647, 95% CI : 1.432-15.086, p=0.005) and a FullRockall score≥8 (OR=6.387, 95% CI : 1.676-24.345, p=0.007) were independently associated with the high risk of death for patients with non-ulcer bleeding. A Glasgow-Blatchford score ≥ 6 (OR=14.996, 95% CI : 6.141 36.502, p<0.001) was a powerful predictor for the need for clinical intervention (blood transfusion, endoscopic hemostasis, surgery and angioembolization) in non-ulcer bleeding. CONCLUSIONS : Patients with non-ulcer bleeding have a similar clinical course as patients with ulcer bleeding. Therefore, we need to be more concerned about the use of scoring systems for the systematic management of non-ulcer bleeding.

PTH-040 Using Nice Criteria To Assess The Management Of Acute Upper Gi Bleeds During Weekends – The Experience Of A District General Hospital

IntroductionThe management of acute upper GI bleeds (AUGIB) comes under greatest stress at weekends; this is a topical concern given the national drive towards a 7 day working week. We...

Sa1677 Risk Scoring Systems in Predicting Intervention and Clinical Outcomes of Bleeding in Patients With Unresectable Gastric Cancer

Pre-endoscopic Rockall score (RS), full RS, and Glasgow-Blatchford bleeding Score (GBS) are increasingly used to stratify the risk in patients with upper gastrointestinal bleeding (UGIB). The aim of this study was to evaluate the efficacy of those bleeding risk scoring systems in patients with UGIB due to unresectable advanced gastric cancer (AGC).

Is the Glasgow Blatchford score useful in the risk assessment of patients presenting with variceal haemorrhage?

The Glasgow Blatchford score (GBS) is a pre-endoscopic risk assessment tool for patients presenting with upper gastrointestinal haemorrhage. There are few data regarding use in patients with variceal bleeding, who are generally accepted as being at high risk. The aim of the study was to assess GBS in correctly identifying patients with subsequently proven variceal bleeding as 'high risk' and to compare GBS, admission and full Rockall scores in predicting clinical endpoints in this group. Data on consecutive patients with upper gastrointestinal haemorrhage presenting to four UK hospitals were collected. The GBS, admission and full Rockall scores were calculated and compared for the subgroup subsequently shown to have variceal bleeding. Area under the receiver operating curve (AUROC) was used to assess the scores ability to predict clinical endpoints within this variceal bleeding subgroup. A total of 1432 patients presented during the study period. Seventy-one (5%) had a final diagnosis of variceal bleeding. At presentation, none of this group had GBS less than 2, but six had an admission Rockall score of 0. In predicting need for blood transfusion, AUROC scores for GBS, full and admission Rockall scores were 0.68, 0.65 and 0.68, respectively. For endoscopic/surgical intervention the scores were 0.34, 0.51 and 0.55, respectively, and for predicting death the scores were 0.56, 0.72 and 0.70, respectively. None of these AUROC score comparisons were significant. At presentation, GBS correctly identifies patients with variceal bleeding as high risk and appears superior to the admission Rockall score. However, GBS and both Rockall scores are poor at predicting clinical outcome within this group.

Acute variceal haemorrhage in the United Kingdom: Patient characteristics, management and outcomes in a nationwide audit

Despite advances in treatment, acute variceal haemorrhage remains life-threatening. To describe contemporary characteristics, management and outcomes of patients with cirrhosis and acute variceal haemorrhage and risk factors for rebleeding and mortality. Multi-centre clinical audit conducted in 212 UK hospitals. In 526 cases of acute variceal haemorrhage, 66% underwent endoscopy within 24h with 64% (n=339) receiving endoscopic therapy. Prior to endoscopy, 57% (n=299) received proton pump inhibitors, 44% (n=232) vasopressors and 27% (n=144) antibiotics. 73% (n=386) received red cell transfusion, 35% (n=184) fresh frozen plasma and 14% (n=76) platelets, with widely varying transfusion thresholds. 26% (n=135) experienced further bleeding and 15% (n=80) died by day 30. The Model for End Stage Liver Disease score was the best predictor of mortality (area under the receiver operating curve=0.74, P<0.001). Neither the clinical nor full Rockall scores were useful predictors of outcome. Coagulopathy was strongly associated with rebleeding (odds ratio 2.23, 95% CI 1.22-4.07, P=0.01, up to day 30) and mortality (odds ratio 3.06, 95% CI 1.29-7.26, P=0.01). Although mortality has improved following acute variceal haemorrhage, rebleeding rates remain appreciably high. There are notable deficiencies in the use of vasopressors and endoscopic therapy. More work is needed to understand the optimum transfusion strategies. Better risk stratification tools are required to identify patients needing more intensive support.

Using an 'action set' for the management of acute upper gastrointestinal bleeding.

We studied the management of patients with acute upper gastrointestinal (GI) bleeding (AUGIB) at the Royal Free Hospital. The aim was to compare our performance with the national standard and determine ways of improving the delivery of care in accordance with the recently published 'Scope for improvement' report. We randomly selected patients who presented with haematemesis, melaena, or both, and had an oesophageogastroduodenoscopy (OGD) between April and October 2009. We developed local guidelines and presented our findings in various forums. We collaborated with the British Medical Journal's Evidence Centre and Cerner Millennium electronic patient record system to create an electronic 'Action Set' for the management of patients presenting with AUGIB. We re-audited using the same standard and target. With the action set, documentation of pre-OGD Rockall scores increased significantly (p ≤ 0.0001). The differences in the calculation and documentation of post-OGD full Rockall scores were also significant between the two audit loops (p = 0.007). Patients who inappropriately received proton-pump inhibitors (PPIs) before endoscopy were reduced from 73.8% to 33% (p = 0.02). Patients receiving PPIs after OGD were also reduced from 66% to 50% (p = 0.01). Discharges of patients whose full Rockall score was less than or equal to two increased from 40% to 100% (p = 0.43). The use of the Action Set improved calculation and documentation of risk scores and facilitated earlier hospital discharge for low-risk patients. Significant improvements were also seen in inappropriate use of PPIs. Actions sets can improve guideline adherence and can potentially promote cost-cutting and improve health economics.

Blatchford score is a useful tool for predicting the need for intervention in cancer patients with upper gastrointestinal bleeding

The Blatchford score is based on clinical and laboratory variables to predict the need for clinical interventions in upper gastrointestinal bleeding (UGIB). The primary object was to evaluate the Blatchford score with clinical and full Rockall scores in patients with active cancer presenting to the emergency department with UGIB. The secondary object was to assess the accuracy of the Blatchford score at different source of UGIB; cancer bleeding versus non-malignant lesions. We reviewed and extracted data from electronic medical record on patients with active cancer presenting to the emergency department from January 2009 to December 2011. Clinical interventions included blood transfusion, therapeutic endoscopy, angiographic intervention, and surgery. Of the 225 patients included, 197 (87.6%) received interventions. Comparing the area under receiver-operator curves, the Blatchford score (0.86, 95% confidence interval [CI] 0.77-0.95) was superior to clinical Rockall (0.67, 95% CI 0.55-0.79) and full Rockall score (0.72, 95% CI 0.61-0.83) in predicting interventions. When the score of 2 or less is counted as negative, sensitivity of 0.99 and specificity of 0.54 were calculated. When the patients were separated according to the source of UGIB, sensitivity and specificity were not changed. The Blatchford score outperformed both Rockall scoring system in predicting intervention in patients with active cancer. The source of bleeding was not important factor in the score performance. The Blatchford score has a very good sensitivity. However, suboptimal specificity limits its role as sole means of decision making in cancer patient with UGIB.

A survey on mortality from non-variceal upper gastrointestinal bleeding: Is the emergency referral system adequate?

Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important cause of mortality and morbidity worldwide. Little information is available on the clinical management of non-variceal upper gastrointestinal bleeding in Italy in relation to the current organization of the Italian Emergency Health Services into Level-I and Level-II Emergency Departments (ED), the latter being more complex structures with greater resources. A retrospective survey on clinical, endoscopic, and survival data was conducted by the regional sections of the 3 main Italian gastroenterological societies, AIGO, SIED and SIGE, recording all consecutive episodes of non-variceal upper gastrointestinal bleeding referred to 7 centres (4 of which were Level-II Emergency Departments) in Rome, Italy, during a one-year period. A total of 624 consecutive patients (64% males, mean age 67.6 ± 16.2 years) were included. Thirty-day mortality was 4.6%. Main factors associated with survival at both univariate and multivariate analysis were the presence of full Rockall score <5 and the admission to a Level-II Emergency Departments (p<0.001). Level-I Emergency Departments admitted patients with a full Rockall score ≥ 5 (p=0.02) more frequently than patients with negative endoscopic findings (p<0.001). Referral of non-variceal upper gastrointestinal bleeding patients to Emergency Departments with more resources (Level-II) is associated with reduced mortality. Yet, unfortunately, high-risk patients were more often admitted to Level-I Emergency Departments, which suggests the need for a better organization of the emergency referral system.

Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit

BackgroundAdmission Rockall score (RS), full RS, and Glasgow-Blatchford Bleeding Score (GBS) can all be used to stratify the risk in patients presenting with upper gastrointestinal bleeding (UGIB) in the emergency department (ED). The aim of our study was to compare both admission and full RS and GBS in predicting outcomes at UGIB patients in a Romanian ED. Patients and MethodsA total of 229 consecutive patients with UGIB were enrolled in the study. Patients were followed up 60 days after admission to ED because of UGIB episode to determine cases of rebleeding or death during this period. By using areas under the curve (AUCs), we compared the 3 scores in terms of identifying the most predictive score of unfavorable outcomes. ResultsRebleeding rate was 40.2% (92 patients), and mortality rate was 18.7% (43 patients). For the prediction of mortality, full RS was superior to GBS (AUC, 0.825 vs 0.723; P = .05) and similar to admission RS (AUC, 0.792). Glasgow-Blatchford Bleeding Score had the highest accuracy in detecting patients who needed transfusion (AUC, 0.888) and was superior to both the admission RS and full RS (AUC, 0.693 and 0.750, respectively) (P < .0001). In predicting the need for intervention, the GBS was superior to both the admission RS and full RS (AUC, 0.868, 0.674, and 0.785, respectively) (P < .0001 and P = .04, respectively). ConclusionsThe GBS can be used to predict need for intervention and transfusion in patients with UGIB in our ED, whereas full RS can be successfully used to stratify the mortality risk in these patients.

A modified Glasgow Blatchford Score improves risk stratification in upper gastrointestinal bleed: a prospective comparison of scoring systems

Several risk scoring systems exist for upper gastrointestinal bleed (UGIB). We hypothesised that a modified Glasgow Blatchford Score (mGBS) that eliminates the subjective components of the GBS might perform as well as current scoring systems. To compare the performance of the mGBS to the most widely reported scoring systems for prediction of clinical outcomes in patients presenting with UGIB. Prospective cohort study from 9/2010 to 9/2011. Accuracy of the mGBS was compared with the full GBS, full Rockall Score (RS) and clinical RS using area under the receiver operating characterstics-curve (AUC). PRIMARY OUTCOME was need for clinical intervention: blood transfusion, endoscopic, radiological or surgical intervention. Secondary outcome was repeat bleeding or mortality. One hundred and ninety-nine patients were included. Median age was 56 with 40% women. Thirty-two per cent patients required blood transfusion, 24% endoscopic interventions, 0.5% radiological intervention, 0 surgical interventions, 5% had repeat bleeding and 0.5% mortality. the mGBS (AUC 0.85) performed as well as the GBS (AUC=0.86, P=0.81), and outperformed the full RS (AUC 0.75, P=0.005) and clinical RS (AUC 0.66, P<0.0001). Secondary outcome: the mGBS (AUC 0.83) performed as well as the GBS (AUC 0.81, P=0.38) and full RS (AUC 0.69, and outperformed the clinical RS (AUC 0.59, P=0.0007). The modified Glasgow Blatchford Score performed as well as the full Glasgow Blatchford Score while outperforming both Rockall Scores for prediction of clinical outcomes in American patients with upper gastrointestinal bleed. By eliminating the subjective components of the Glasgow Blatchford Score, the modified Glasgow Blatchford Score may be easier to use and therefore more easily implemented into routine clinical practice.

Multicentre comparison of the Glasgow Blatchford and Rockall scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage

The Glasgow Blatchford Score (GBS) is increasingly being used to predict intervention and outcome following upper gastrointestinal haemorrhage (UGIH). To compare the GBS with both the admission and full Rockall scores in predicting specific clinical end-points following UGIH. Data on consecutive patients presenting to four UK hospitals were collected. Admission history, clinical and laboratory data, endoscopic findings, treatment and clinical follow-up were recorded. Using ROC curves, we compared the three scores in the prediction of death, endoscopic or surgical intervention and transfusion. Results A total of 1555 patients (mean age 56.7years) presented with UGIH during the study period. Seventy-four (4.8%) died, 223 (14.3%) had endoscopic or surgical intervention and 363 (23.3%) required transfusion. The GBS was similar at predicting death compared with both the admission Rockall (area under ROC curve 0.804 vs. 0.801) and full Rockall score (AUROC 0.741 vs. 0.790). In predicting endo-surgical intervention, the GBS was superior to the admission Rockall (AUROC 0.858 vs. 0.705; P<0.00005) and similar to the full Rockall score (AUROC 0.822 vs. 0.797). The GBS was superior to both admission Rockall (AUROC 0.944 vs. 0.756; P<0.00005) and full Rockall scores (AUROC 0.935 vs. 0.792; P<0.00005) in predicting need for transfusion. Despite not incorporating age, the GBS is as effective as the admission and full Rockall scores in predicting death after UGIH. It is superior to both the admission and full Rockall scores in predicting need for transfusion, and superior to the admission Rockall score in predicting endoscopic or surgical intervention.

Is the Glasgow Blatchford Score useful in the risk assessment of patients presenting with variceal haemorrhage?

IntroductionThe Glasgow Blatchford Score (GBS) is a pre-endoscopic risk assessment tool for patients presenting with upper gastrointestinal haemorrhage (UGIH). It can predict need for intervention or death and identifies low...

W1039 Can We Predict Length of Stay in Patients Admitted With Acute Upper Gastrointestinal Bleeding?

Introduction Acute upper gastrointestinal bleeding (AUGIB) is a common cause of admission to hospital in the UK with an annual incidence of 50–150 per 100 000 cases and a stubbornly high mortality of around 10–14%. Thus AUGIB represents a huge economic burden to the NHS. Enabling clinicians and bed managers to predict the likely length of stay of those patients admitted could aid triage to an appropriate hospital area and facilitate the multidisciplinary team in discharge planning. We analysed if length of hospital stay can be predicted from the clinical and/or full Rockall score. Methods Further analyses were performed on patients included in the 2007 UK Comparative Audit of Upper Gastrointestinal Bleeding and the Use of Blood.1 In this study prospective data were collected electronically on consecutive patients presenting to all UK hospitals with AUGIB between 1 May and 30 June 2007. Results Data were available on 6750 patients across 208 UK hospitals. We restricted this analysis to new admissions with AUGIB (5550/6750). A clinical Rockall score was available for 5550 patients and a full (post endoscopy) Rockall score for 4095 patients. We analysed the median length of stay by clinical and full Rockall score for all new patients admitted with AUGIB. The median length of stay for a clinical Rockall score of 0–1 was 3 days. The median length of stay for a full Rockall score of zero was 2 days- each one point increase in the full Rockall score corresponded to one extra day in hospital. Non-parametric, two-tailed Spearman coefficient calculation demonstrated the correlation between Rockall score and length of stay was highly significant for both the clinical score (r=0.291, p Conclusion The Rockall score was originally developed as a tool to predict mortality from AUGIB. In this retrospective analysis, we have shown that both the clinical and full Rockall score can be used to predict length of hospital stay for patients presenting with AUGIB. We have also demonstrated a median length of hospital stay of 3 days for patients with a clinical Rockall score of 0–1 which could be deemed excessive given recent further evidence supporting discharge followed by early outpatient endoscopy for such low risk patients.2

OC-022 Multicentre comparison of the Glasgow Blatchford and Rockall scores in the prediction of clinical endpoints in upper gastrointestinal haemorrhage

Introduction The pre-endoscopic Glasgow Blatchford Score (GBS) can identify low-risk patients with upper gastrointestinal haemorrhage (UGIH) who may be suitable for out-patient management. Although it does not include the patient9s age, the GBS appears to have high accuracy in predicting clinically relevant endpoints. Our aim was to compare the GBS with both the pre-endoscopy (admission) and post-endoscopy (full) Rockall scores in predicting need for clinical intervention and mortality. Methods Data on consecutive patients presenting to four UK hospitals (Glasgow Royal Infirmary, Royal Cornwall Hospital Truro, University Hospital of North Tees and Ninewells Hospital Dundee) were collected. Admission history, clinical and laboratory data, endoscopic findings and treatment, and clinical follow-up were recorded. We used ROC curves to compare the three scores in the separate prediction of death, endoscopic or surgical intervention and transfusion. Results 1556 patients (mean age 56.7 years; 62% male) presented with UGIH to the four hospitals during the study period. 74 (4.8%) died, 223 (14.3%) had endoscopic or surgical intervention and 363 (23.3%) required transfusion. The GBS was equally effective at predicting death compared with both the admission Rockall score (area under ROC curve 0.804 vs 0.801) and the full Rockall score (AUROC 0.741 vs 0.790). In predicting endo/surgical intervention, the GBS was superior to the admission Rockall score (AUROC 0.858 vs 0.705, p Conclusion Despite not incorporating age, the GBS is as effective as the admission and full Rockall scores in predicting death after UGIH. It is superior to both the admission and full Rockall scores in predicting need for transfusion and superior to the admission Rockall score in predicting endoscopic or surgical intervention.

S1385: Multicentre Comparison of the Glasgow Blatchford and Rockall Scores in the Prediction of Clinical End-Points in Upper GI Haemorrhage

The pre-endoscopic Glasgow Blatchford Score (GBS) can identify low-risk patients with upper gastrointestinal haemorrhage (UGIH) who may be suitable for out-patient management. Despite not including the patient's age, the GBS appears to have high accuracy in predicting clinically relevant end-points including death. Our aim was to compare the GBS with both the pre-endoscopy (admission) and post-endoscopy (full) Rockall scores in predicting clinical intervention and mortality.

Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation

Upper-gastrointestinal haemorrhage is a frequent reason for hospital admission. Although most risk scoring systems for this disorder incorporate endoscopic findings, the Glasgow-Blatchford bleeding score (GBS) is based on simple clinical and laboratory variables; a score of 0 identifies low-risk patients who might be suitable for outpatient management. We aimed to evaluate the GBS then assess the effect of a protocol based on this score for non-admission of low-risk individuals. Our study was undertaken at four hospitals in the UK. We calculated GBS and admission (pre-endoscopy) and full (post-endoscopy) Rockall scores for consecutive patients presenting with upper-gastrointestinal haemorrhage. With receiver-operating characteristic (ROC) curves, we compared the ability of these scores to predict either need for clinical intervention or death. We then prospectively assessed at two hospitals the introduction of GBS scoring to avoid admission of low-risk patients. Of 676 people presenting with upper-gastrointestinal haemorrhage, we identified 105 (16%) who scored 0 on the GBS. For prediction of need for intervention or death, GBS (area under ROC curve 0.90 [95% CI 0.88-0.93]) was superior to full Rockall score (0.81 [0.77-0.84]), which in turn was better than the admission Rockall score (0.70 [0.65-0.75]). When introduced into clinical practice, 123 patients (22%) with upper-gastrointestinal haemorrhage were classified as low risk, of whom 84 (68%) were managed as outpatients without adverse events. The proportion of individuals with this condition admitted to hospital also fell (96% to 71%, p<0.00001). The GBS identifies many patients presenting to general hospitals with upper-gastrointestinal haemorrhage who can be managed safely as outpatients. This score reduces admissions for this condition, allowing more appropriate use of in-patient resources.