Rockall Score Research Articles

GLASGOW-BLATCHFORD AND ROCKALL SCORE UTILITY IN PREDICTING FINDINGS ON VIDEO CAPSULE ENDOSCOPY IN PATIENTS ADMITTED WITH OVERT SMALL BOWEL BLEEDING

Background and Aims Glasgow-Blachford (GBS) and Rockall scores are recognised tools to prioritize patients with upper gastrointestinal bleeding. Its utility in predicting findings on capsule endoscopy (CE) in patients with overt small bowel bleeding (OSBB) remains unclear. The aim was to assess the use of these scores in predicting relevant findings on CE and outcome among patients with suspected OSBB. Methods Retrospective analysis from January 2019 to June 2022. Clinical parameters and scores were collected at presentation and at 24 hours. Univariate analysis used simple logistic regression, chi-squared test or Mann-Whitney as needed. ROC analysis was performed selecting the optimal cut-off point maximized by the Youden index. Results 79 patients were included. 62% had relevant findings. The predictor showing the highest discrimination ability was the Initial GBS (AUC 0.625 95%CI 0.49 – 0.76). The optimal cut-off point was at least 4, with a sensitivity 98%, specificity 30% and accuracy 72%. Multivariable regression analysis showed inpatient status on CE (OR 117.27; CI 11.32 – 4492.93; p=0.001), shorter time to CE (OR 1.02; CI 1.01 – 1.04 p=0.018), higher initial GBS (OR 1.22; CI 1.06 – 1.43 p=0.009) and higher GBS within 24 hours (OR 1.19; CI 1.04 – 1.37 p= 0.013) were predictive factors for relevant findings on CE, with a model AUC 0.802, Sensitivity 91.8% and Specificity 63.3%. Conclusions GBS and Rockall score were useful in predicting relevant findings on CE in this cohort of patients with suspected OSBB. In patients with GBS 5 or higher, an early CE during the same admission, is warranted.

Comparative diagnostic utility of Rockall and Glasgow-Blatchford scores in non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis.

The Rockall score and Glasgow-Blatchford score (GBS) are two scoring systems validated in the evaluation of upper gastrointestinal bleeding (UGIB). However, no meta-analysis exists to summarize the current data and clarify the use of Rockall score and GBS focusing on non-variceal UGIB. We aimed to evaluate and compare the utility of the Rockall score and GBS in predicting clinical outcomes in non-variceal UGIB. We conducted a systematic review and meta-analysis, searching the MEDLINE and EMBASE databases for all peer-reviewed articles using the terms including 'Glasgow-Blatchford', 'Rockall', and 'gastrointestinal bleed' from their inception to 22 March 2023. Outcomes included mortality, rebleeding, need for blood transfusion, and need for surgical intervention. Seven studies with 755 participants with non-variceal bleeding were included in the analysis. Pooled analysis demonstrated no difference in the area under the receiver operating characteristic (AUROC) between GBS and Rockall score to predict mortality [weighted mean difference (WMD) = 0.01, 95% CI: -0.06 to 0.08] or rebleeding (WMD = 0.04, 95% CI: -0.03 to 0.11). GBS had a higher AUROC to predict the outcomes compared to Rockall score for the needs for transfusion (WMD = 0.09, 95% CI: 0.01-0.16) and surgical intervention (WMD = 0.21, 95% CI: 0.14-0.29). The GBS could be superior to the Rockall score in predicting the needs for transfusion and surgical intervention in non-variceal UGIB. However, both scores demonstrate low performance for predicting mortality or rebleeding.

Clinical Outcomes of Peptic Ulcer Bleeding

Despite advancements in endoscopic technology and drug therapy, the high mortality and rebleeding rates associated with hemorrhagic peptic ulcers remain a concern. Although further research is needed to validate contributing factors, I recommend use of the Rockall score to predict the rebleeding risk in patients with peptic ulcers. Greater caution should be exercised, particularly in hospitalized patients, those who have undergone pancreatic surgery, and those with bleeding due to Dieulafoy’s lesions. Delaying resumption of an oral diet for at least 24 hours after endoscopic bleeding control is also advisable.

Evaluation of Rockall and Blatchford Scores and Forrest Staging in Upper Gastrointestinal Bleeding

Objective: The study aimed to investigate the predictive value of Rockall and Blatchford scores and endoscopic Forrest staging in the need for transfusion and intensive care in upper gastrointestinal bleeding. Materials and Methods: This retrospective study was conducted on 294 patients with gastrointestinal bleeding who presented to the emergency department between January 1 and June 1, 2013. Results: The mean age of 294 patients was 58.73±21.30 years. The endoscopic diagnoses of the patients included peptic ulcer (43.5%, n=128), erosive gastritis (17.3%, n=51), and erosive bulbitis (12.6%, n=37). There was no statistically significant relationship between Forrest staging and Rockall and Blatchford scores (p=0.944, p=0.757). The need for blood transfusion was significantly more frequent in patients with a Rockall score of 5 and above and those with a high Blatchford score (p=0.004, p=0.001). Patients with a Rockall score of 5 and above were significantly more common among those referred to the intensive care unit (p=0.003). Conclusion: Pre-endoscopic Rockall and Blatchford scores and endoscopic Forrest staging can be used safely in predicting transfusion requirement, intensive care requirement, mortality risk, treatment and follow-up of patients with gastrointestinal bleeding, and thus may help to reduce health expenditures.

WP7.13 - Recognising Clinical frailty in the Periooperative setting in the Acute Surgical Unit

Abstract Aim Due to an ageing population the number of elderly patients undergoing surgery is increasing. The literature and NELA guidance has highlighted frailty can lead to increased risks related to surgery, quantified by Clinical frailty scoring. With the introduction of the regions first Perioperative care for Older People undergoing Surgery (POPS) service, we aim to determine if formal documentation of clinical frailty score improved awareness of these patients and impacted on clinical outcomes. Methods A 3 week note review was completed of all patients over 65 admitted to the acute surgical emergency unit. Frailty was scored using the Rockall Score. The first cycle was a review of current documentation practice, with a subsequent cycle of documentation of frailty score following interventions included; clinical posters in clinical areas, teaching and medical and nursing staff handover. Results At baseline zero patient had a Rockall Clinical frailty score CFS documented. There has been an increase in the number of patients >65 years old who have a frailty score documented within 24 hours of admission. 15/40 patients over 65 had a CFS documented improved by 37.8%. Conclusion Overall improvement of documentation and awareness has been demonstrated highlighting higher frailty patients and those for POPS review to improve perioperative outcomes.

Evaluation of Glaskow-Blatchford, Rockall Scores and Shock Index of Patients Admitted from the Emergency Department with A Diagnosis of Upper Gastrointestinal System Bleeding

Background: Risk scores and shock index used in upper gastrointestinal system (GSB) bleeding have an important place in determining the treatment and clinical course of the patient. The aim of this study is to evaluate the predicted success in mortality by analyzing shock indices together with Glasgow Blatchford Scoring (GBS) and Rockall Scoring (RS), whichare used in upper GI bleeding. Methods: This study was conducted with a retrospective analysis of patients who were hospitalized with a diagnosis of upper GI bleeding from the emergency department of a single-center secondary care health institution. For each patient, age, gender, treatment procedures performed in the emergency department or clinic, and endoscopy results were evaluated. Mortality and discharge status of the patients were compared with the scoring values. Result: 86 patients were evaluated in the study. The average age was 69.09±19.07 and the most applications were in the 61-79 age range (48.8%). The most common presenting complaints of the patients were bloody vomiting and black stools. On physical examination, melena was positive in 64% of the patients. 89.5% of the patients were treated in intensive care. The mortality rate was 10.5%. In patients with death, the shock index value was ≥0.75 in all patients and the average was 1.07. As a result of the study, it was seen that GBS, RS and shock index were successful in predicting mortality. Conclusion: Current scoring systems need to be developed in order to manage patients with upper GI bleeding, which is frequently seen in emergency departments today, more quickly and to reduce patient costs.

Predictive utility of the Rockall scoring system in patients suffering from acute nonvariceal upper gastrointestinal hemorrhage.

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) represents a significant clinical challenge due to its unpredictability and potentially severe outcomes. The Rockall risk score has emerged as a critical tool for prognostic assessment in patients with ANVUGIB, aiding in the prediction of rebleeding and mortality. However, its applicability and accuracy in the Chinese population remain understudied. To assess the prognostic value of the Rockall risk score in a Chinese cohort of patients with ANVUGIB. A retrospective analysis of 168 ANVUGIB patients' medical records was conducted. The study employed statistical tests, including the t-test, χ 2 test, spearman correlation, and receiver operating characteristic (ROC) analysis, to assess the relationship between the Rockall score and clinical outcomes, specifically focusing on rebleeding events within 3 months post-assessment. Significant associations were found between the Rockall score and various clinical outcomes. High Rockall scores were significantly associated with rebleeding events (r = 0.735, R 2 = 0.541, P < 0.001) and strongly positively correlated with adverse outcomes. Low hemoglobin levels (t = 2.843, P = 0.005), high international normalized ratio (t = 3.710, P < 0.001), active bleeding during endoscopy (χ 2 = 7.950, P = 0.005), large ulcer size (t = 6.348, P < 0.001), and requiring blood transfusion (χ 2 = 6.381, P = 0.012) were all significantly associated with rebleeding events. Furthermore, differences in treatment and management strategies were identified between patients with and without rebleeding events. ROC analysis indicated the excellent discriminative power (sensitivity: 0.914; specificity: 0.816; area under the curve: 0.933; Youden index: 0.730) of the Rockall score in predicting rebleeding events within 3 months. This study provides valuable insights into the prognostic value of the Rockall risk score for ANVUGIB in the Chinese population. The results underscore the potential of the Rockall score as an effective tool for risk stratification and prognostication, with implications for guiding risk-appropriate management strategies and optimizing care for patients with ANVUGIB.

Comparative analysis of four upper gastrointestinal bleeding scoring systems for predicting multiple outcomes: an observational study in the emergency department

Objective: Numerous scoring systems have been developed to assess the risk associated with upper gastrointestinal bleeding (UGIB), and several studies have investigated their comparative accuracy in predicting patient outcomes. This study was undertaken to compare four well-known scoring systems, namely the pre-endoscopy Rockall score, full Rockall score, Glasgow-Blatchford Bleeding score (GBS), and AIMS65, with the aim of predicting five distinct outcomes in cases of non-variceal UGIB. Methods: This prospective observational study was conducted focusing on adult patients with UGIB presenting to the emergency department (ED). The primary endpoints of this study included in-hospital mortality, the need for re-endoscopy, the requirements for packed red blood cell (PRBC) transfusion, massive transfusion, and one-month rebleeding. Results: A total number of 320 patients were enrolled, with 44 (13·75%) in-hospital deaths. Based on the area under the curves (AUC), while certain scores outperformed others in specific outcome prediction, the AIMS65 scoring system demonstrated superior predictive capability for both in-hospital mortality (0.91) and massive transfusion (0.71). Regarding PRBC transfusion requirements, both AIMS65 and GBS exhibited similar predictive capacities (AUC=0.67 and 0.68, respectively). In terms of re-endoscopy and one-month rebleeding, the GBS scoring system displayed slightly better performance compared to the other systems (AUC=0.61 and 0.63, respectively). In the composite outcome, all scores had significant associations, and among them, the AIMS-65 score had the highest AUC (0.76). Conclusion: The AIMS65 scoring system was the most reliable tool for predicting in-hospital mortality and, to a lesser extent, massive transfusion requirements, while GBS and AIMS65 could be moderately and cautiously relied on for preparations regarding the need for PRBC transfusion.

Prognostic Significance of the Hemoglobin-Albumin Ratio in Upper Gastrointestinal Bleeding

ABSTRACT Objective Upper gastrointestinal bleeding is a serious and life-threatening condition where monitoring and prognosis are crucial. This study aimed to compare the prognostic value of the hemoglobin-albumin ratio (HAR) with endoscopic risk scoring systems. Methods The medical records of 153 patients with upper gastrointestinal bleeding treated at our clinic between 2022 and 2024 were retrospectively reviewed. Endoscopic risk scoring systems, including the Rockall score (RS), Glasgow-Blatchford score (GBS), and Forrest classification, were calculated. The HAR score, consisting of hematologic parameters, was computed. The HAR score was compared with clinical findings and endoscopic scores using the Mann-Whitney U and Kruskal-Wallis tests. The relationships between the HAR values and numerical variables were examined using Spearman’s correlation coefficient. Results Of the patients, 122 (79.7%) were male and 31 (20.3%) were female. A duodenal ulcer was the most common endoscopic finding (43.7%). The mean GBS was 10.69±3.89, RS was 4.37±2.27, and HAR was 2.88±0.64. There was a low-level significant correlation between the HAR score and the Glasgow Blatchford score (r=-0.254, p=0.002). Low hemoglobin levels, a low HAR score, and a high GBS were associated with a poor prognosis. Conclusion In patients with upper gastrointestinal bleeding, a low HAR score is associated with a poor prognosis. The HAR score is an effective and reliable marker, similar to endoscopic scoring systems. This study revealed a correlation between a high GBS and a low HAR score. Due to its simplicity, rapid and easy calculation, and practicality, the HAR score can be used routinely in clinical practice.

Prognostic scores for predicting clinical outcomes in upper gastrointestinal bleeding

Background and aimsThis study aimed to determine the performance of AIMS65, Rockall score, and Glasgow-Blatchford score (GBS) in patients presenting with upper gastrointestinal bleeding (UGIB) and to compare results between patients with nonvariceal UGIB (NVUGIB) and variceal UGIB (VUGIB).MethodsWe conducted a single-center prospective cohort study between December 2021 and December 2022. A total of 400 patients who met the inclusion criteria were included in the study, out of which 232 patients (58%) had NVUGIB and 168 patients (42%) had VUGIB. Receiver operating characteristic curve analysis was performed for all outcomes for comparison.ResultsOf the total of 400 patients with UGIB, 232 patients (58%) had NVUGIB, and 168 patients (42%) had VUGIB. The present study showed that GBS (AUROC 0.729, 95% CI: 0.598–0.859, p = 0.001) and RS (AUROC 0.693, 95% CI: 0.579–0.807, p = 0.005) but not AIMS65 (AUROC, 0.545, 95% CI: 0.412–0.679, p = 0.500) predicted in-hospital and overall 6-week mortality in patients with UGIB. All the three scores predicted need for blood transfusion and poor composite outcomes (p < 0.05). The need for endoscopic intervention was predicted by all the three scores in overall UGIB (OUGIB) patients (p < 0.05), only GBS and RS in NVUGIB patients (p < 0.05). Rebleeding was best predicated by RS in both OUGIB and NVUGIB patients (p < 0.05). None of the scores predicted the need for endoscopic intervention, rebleeding, need for surgical and radiological intervention, and composite outcomes in VUGIB patients (p > 0.05).ConclusionsGBS and RS were superior to AIMS65 in predicted in-hospital and overall 6-week mortality in all the three categories: OUGIB, NVUGIB, and VUGIB patients.

Evaluation of the effect of parenteral nutrition on mortality and morbidity in hospitalized patients with non-variceal upper gastrointestinal bleeding

Objective: Nutritional support products should preferably be administered orally whenever possible, with rare exceptions, one of which is gastrointestinal bleeding. In our study, we examined the effects of parenteral nutrition support, which we have recently introduced in the treatment of patients with gastrointestinal bleeding, on the hospitalization duration and mortality-morbidity of these patients. Methods: We analyzed the patients admitted to the Internal Medicine Service with non-variceal upper gastrointestinal bleeding in our study. Patients were retrospectively analyzed in two groups, based on the years in which total parenteral nutrition (TPN) was initiated (2016-2017) and not initiated (2012-2013). Hospitalization durations and discharge methods were compared between the two groups. Results: Our study included a total of 369 cases after screening and application of our exclusion criteria. 35.5% of these cases received TPN, while 64.5% did not. When evaluated based on the TPN administration status after stabilizing the Rockall score of the patients, as well as considering the need for erythrocyte suspension (ES), fresh frozen plasma (FFP) replacement, and length of hospital stay, the length of hospital stay was significantly longer in those receiving TPN compared to those who did not. Conclusion: Although TPN may be the preferred choice in patients with upper gastrointestinal bleeding for whom oral nutrition is not suitable, our study suggests that this preference not only does not lead to a reduction in the number of blood and blood product replacements but also prolongs the hospital stay. While it is believed that complications of nutritional support with TPN may contribute to this result, our retrospective study did not provide data on this. Comprehensive prospective studies are needed on this issue.

MH-STRALP: A scoring system for prognostication in patients with upper gastrointestinal bleeding.

Upper gastrointestinal bleeding (UGIB) is a common medical emergency and early assessment of its outcomes is vital for treatment decisions. To develop a new scoring system to predict its prognosis. In this retrospective study, 692 patients with UGIB were enrolled from two centers and divided into a training (n = 591) and a validation cohort (n = 101). The clinical data were collected to develop new prognostic prediction models. The endpoint was compound outcome defined as (1) demand for emergency surgery or vascular intervention, (2) being transferred to the intensive care unit, or (3) death during hospitalization. The models' predictive ability was compared with previously established scores by receiver operating characteristic (ROC) curves. Totally 22.2% (131/591) patients in the training cohort and 22.8% (23/101) in the validation cohort presented poor outcomes. Based on the stepwise-forward Logistic regression analysis, eight predictors were integrated to determine a new post-endoscopic prognostic scoring system (MH-STRALP); a nomogram was determined to present the model. Compared with the previous scores (GBS, Rockall, ABC, AIMS65, and PNED score), MH-STRALP showed the best prognostic prediction ability with area under the ROC curves (AUROCs) of 0.899 and 0.826 in the training and validation cohorts, respectively. According to the calibration curve, decision curve analysis, and internal cross-validation, the nomogram showed good calibration ability and net clinical benefit in both cohorts. After removing the endoscopic indicators, the pre-endoscopic model (pre-MH-STRALP score) was conducted. Similarly, the pre-MH-STRALP score showed better predictive value (AUROCs of 0.868 and 0.767 in the training and validation cohorts, respectively) than the other pre-endoscopic scores. The MH-STRALP score and pre-MH-STRALP score are simple, convenient, and accurate tools for prognosis prediction of UGIB, and may be applied for early decision on its management strategies.

Comparison of Rockall Score and MELD Score for Predicting in Hospital Mortality Patients with Vericeal Bleeding

Comparison of Rockall Score and MELD Score for Predicting in Hospital Mortality Patients with Vericeal Bleeding

Diagnostic value of liver stiffness measurement combined with risk scores for esophagogastric variceal bleeding in patients with hepatitis B cirrhosis

PurposeTo assess the predictive value of liver stiffness measurement (LSM) and three bleeding risk scoring systems for esophagogastric varices bleeding (EGVB) in patients with hepatitis B cirrhosis during hospitalization. MethodsIn this study, 210 patients who had hepatitis B cirrhosis were selected as the subjects. They were categorized into two groups based on whether EGVB occurred during hospitalization: a bleeding group (70 cases) and a non-bleeding group (140 cases). Logistic regression was used to analyze the factors related to the occurrence of EGVB, and the diagnostic performance was evaluated using a receiver operating characteristic (ROC) curve. ResultsSignificant differences were observed between the two groups in systolic blood pressure, platelet count, albumin, urea nitrogen, LSM, pre-endoscopic Rockall score (PRS), Glasgow-Blatchford score (GBS), and AIMS65 score (P < 0.05). The correlation analysis showed that LSM had significant positive relationship with PRS, GBS and AIMS65 score. Logistic regression analysis revealed that LSM and GBS score were independent risk factors for EGVB occurrence during hospitalization. ROC curve analysis showed that the combined prediction model of LSM and GBS score had the best prediction performance for EGVB occurrence, with an ROC curve area of 0.811, which was significantly better than the three risk scoring systems (P < 0.05), but similar to the predicted value of LSM (P = 0.335). ConclusionsThe combination of LSM and GBS score can significantly improve the predictive efficacy of EGVB occurrence in patients with hepatitis B cirrhosis during hospitalization, which has important clinical significance for patients' prognosis.

A216 MODERATE TO SEVERE ACUTE UPPER GASTROINTESTINAL BLEEDING IN RURAL NORTHERN ONTARIO: AN EPIDEMIOLOGICAL ANALYSIS OF AETIOLOGIES, GEOGRAPHIC LIMITATIONS, AND OUTCOMES

Abstract Background Hospitalizations for upper gastrointestinal bleeds (UGIBs) are resource-demanding as they often require blood transfusion, endoscopy, and intensive care unit admission. Referral centers that provide higher levels of care to remote regions treat illnesses, including UGIB, in much later stages of disease and of higher severity. The Thunder Bay Regional Health Sciences Center (TBRHSC) is a referral center servicing over 250,000 people over a geographically expansive region of Northern Ontario. Despite known barriers to accessing care, little data is currently available to guide our understanding of UGIB aetiologies, severity, and outcomes among patients living remotely in Canada. Aims This retrospective study aimed to evaluate epidemiological data among patients with UGIB at TBRHSC. Methods Of 441 patients with a discharge diagnosis of gastrointestinal hemorrhage from 2016–2022, inclusion criteria were met for 333. Patients under 18 y or with lower GIB were excluded. Patients were classified as regional if their primary address was outside the District of Thunder Bay. Results Patients were highly comorbid (median CCI = 5) and presented with a median (IQR) GBS of 9 (6) and Clinical Rockall Score of 3 (1). Of those who received inpatient endoscopy (n=248), findings included erosive gastritis (21%), gastric ulcer (14%), esophagitis (12%), duodenal ulcer (8%), AVM (7%), and variceal (6%). No definite lesion was observed in 62 patients (22%). The median (IQR) Complete Rockall Score was 4 (2) with major stigmata of recent hemorrhage found in 20%. There was a high prevalence (19%) of cirrhosis, of which 83% had a history of liver decompensation. In 49% of cirrhotic patients, culprit lesions did not include portal hypertensive gastropathy or variceal bleeding. Regional patients accounted for 14% of the population and travelled an average of 424 km to seek care at TBRHSC. Regional patients were younger and required more ICU admissions (p=0.01). ICU admission primarily due to UGIB was 5.4% and all-cause thirty-day mortality was 3.3%. Oral anti-coagulation use prevalence was 43.2% and was associated with a longer length of stay (pampersand:003C0.0001), higher proportion of all-cause 30-day mortality (pampersand:003C0.005). Forty-eight patients did not receive endoscopy due to bleeding stability, palliation, and preference. Conclusions Patients with UGIB at TBRHSC are a highly multimorbid population with a significantly burden of anticoagulant use, cirrhosis, and variceal bleeding. Comparative analysis with metropolitan centers will expand our understanding for providing UGIB care in Northern Ontario. Funding Agencies NOAMA

A142 PROGNOSTICATING FACTORS AND OUTCOMES OF EARLY ENDOSCOPIC EVALUATION IN ACUTE UPPER GASTROINTESTINAL BLEEDING

Abstract Background Current guidelines recommend esophagogastroduodenal endoscopy (EGD) early (ampersand:003C24 hours after presentation) for all suspected acute upper gastrointestinal bleeds (AUGIB). Among referral centers providing advanced tiers of care to large regions, treatment is often delayed secondary to geographic constraints. Metropolitan centers meet early EGD recommendations in up to 87.5% of patients. Some centers limit endoscopy to the ICU setting outside of normal hospital operational times. There is currently no data assessing Canadian referral center endoscopic timing, including factors delaying AUGIB endoscopy and outcomes. Aims The aim of this study was to report the prevalence of early EGD in AUGIB at a Northern Ontario referral center. Factors associated with delayed EGD and poor outcomes associated with AUGIB were also evaluated. Methods Of 441 patients retrospectively identified with an ICD-10 discharge diagnosis of gastrointestinal hemorrhage from 2016–22, 327 patients met inclusion criteria. Patients were excluded if they were below the age of 18 years at the time of presentation, had chronic UGIB, or lower gastrointestinal hemorrhage. Results Pre-endoscopic risk stratification via GBS and clinical Rockall score was high at 10 and 3, respectively. There were 279 patients who received early EGD for AUGIB, of which 56% were male. The median (IQR) time to endoscopy was 27.4 (29.3) hours with early EGD achieved in 46% of presentations. A significantly greater proportion of patients presenting to hospital on the weekend (n=105) had delayed EGD (pampersand:003C0.0001; Phi effect size 0.45). Patients presenting at times when EGD was unavailable (n=157) also experienced delayed EGD (pampersand:003C0.05). regional patients did not experience a greater proportion of delayed EGD. In multivariate analysis, presentation on the weekend, higher CCI, absence of pre-existing evidence of liver cirrhosis, and absence of major stigmata of recent hemorrhage on EGD were independent predictors of delayed EGD (Nagelkerke R2 = 0.379, pampersand:003C0.0001). The odds ratio for receiving late EGD was 8.9 times greater (95% CI 3.7–21.3) for patients presenting on the weekend (pampersand:003C0.0001). Longer endoscopy wait time was significant correlated with higher pre-EGD blood transfusions and longer length of stay (pampersand:003C0.001). Delayed EGD did not increase all-cause 30-day mortality. Conclusions Prevalence of delayed EGD in AUGIB was markedly elevated and associated with hospital presentation during times of limited endoscopic capabilities. Outcomes of delayed GED included increased length of stay and higher blood transfusion rates. Funding Agencies NOAMA

Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department.

This study investigates the effectiveness of bedside ultrasonography in predicting blood transfusion requirements in patients with upper gastrointestinal bleeding (UGIB). It focuses on evaluating the inferior vena cava (IVC) diameter, IVC collapsibility index (CI), and stroke volume (SV) as ultrasonographic measures. A hundred adult patients enrolled in this prospective clinical study. The patients were divided into two groups (group 1: only saline administered group, group 2: saline and blood administered group). IVC diameter, IVC CI, and SV were measured at the time of admission and after treatment. At the initial admission, group 1 exhibited an IVC CI of 20.4% and an SV of 65.0mL, whereas group 2 displayed an IVC CI of 26.6% and an SV of 58.0mL. Upon analyzing the relationship between the Glasgow-Blatchford score (GBS) and SV, we identified a significant negative correlation (r=-0.7350; P<0.001). Similarly, a weak negative correlation was observed between the Rockall score (RS) and SV (r=-0.4718; P<0.001). It is worth noting that patients with UGIB require blood transfusion if their SV falls below 62.5mL, with an area under the curve (AUC) of 89.1% and a 95% confidence interval (CI) ranging from 82.8% to 95.4%. IVC CI and SV can be used as parameters to predict the need for blood transfusion in the ED in patients with UGIB.

Evaluating the Effectiveness of Modified Early Warning, Glasgow Blatchford, and Pre - Endoscopic Rockall Scoring Systems in Predicting Outcomes of Upper Gastrointestinal Bleeding in Emergency Care

Evaluating the Effectiveness of Modified Early Warning, Glasgow Blatchford, and Pre - Endoscopic Rockall Scoring Systems in Predicting Outcomes of Upper Gastrointestinal Bleeding in Emergency Care

Neutrophil-lymphocyte ratio predict outcome of upper gastrointestinal bleeding in emergency.

The neutrophil-lymphocyte ratio (NLR) is a simple marker of systemic inflammatory responses. The present study aims to evaluate the prognostic significance of the NLR on admission day in predicting outcomes for patients with upper gastrointestinal bleeding (UGIB), which is a prevalent medical emergency. 726 patients who were admitted to our clinic between January 2019 and December 2022 diagnosed with UGIB, and who underwent necessary examinations, were included in the study. The patients' Glasgow-Blatchford Score (GBS), Full Rockall Score (FRS), and NLR levels were calculated at the first admission. Outcomes were defined as in-hospital mortality, need for blood transfusion, surgical treatment and endoscopic therapy. Patients were categorized into four groups using NLR quartile levels to compare their clinical characteristics, Glasgow Blatchford Score, Full Rockall Score levels, and prognosis. Secondary, we modified FRS and GBS by adding NLR, respectively. We used area under the receiver operating characteristic curve (AUROC) to assess the accuracy of risk prediction for NLR, NLR-GBS, and NLR-FRS improved models. Of 726 patients, 6% died in hospital, 23.9% received endoscopic interventon, 4.8% received surgical treatment, and 46.4% received transfusion therapy. Multifactorial logistic regression showed that a high level of NLR was a risk factor for death in patients with UGIB (p = 0.028). NLR, GBS, FRS, NLR-GBS, and NLR-FRS have sufficient accuracy in predicting inpatient mortality, endoscopic treatment, and transfusion treatment, and the differences are statistically significant (p < 0.05). In the comprehensive prediction of adverse outcomes, NLR-GBS has the highest AUROC, and in predicting inpatient mortality, NLR-FRS has the highest AUROC. For UGIB patients, a high NLR was strongly associated with high risk UGIB. Combined testing with the GBS and FRS can achieve good predictive results, which is valuable in guiding the pre-screening and triage of emergency nursing care and clinical treatment to ensure that patients receive rapid and effective treatment and improve the quality of care.

Use of a neuro-fuzzy technique to predict complete Rockall score in patients with upper gastrointestinal bleeding

Use of a neuro-fuzzy technique to predict complete Rockall score in patients with upper gastrointestinal bleeding