Safe discharge of patients with low-risk upper gastrointestinal bleeding (UGIB): can use of Glasgow-Blatchford Bleeding Score (GBS) be extended?

Introduction Risk stratification of patients with suspected UGIB using either Glasgow-Blatchford Bleeding Score or pre-endoscopy Rockall score to facilitate early safe discharge (GBS = 0, pre-Rockall = 1) has been reported.12 This observational study compared score utility and considered the impact of extending the range of GBS or pre-Rockall scores permitting safe discharge. Methods Consecutive adult patients presenting from September 2008-March 2009 with suspected UGIB to acute medicine and the emergency department had clinical history, vital signs, laboratory and endoscopy results prospectively recorded using electronic databases. GBS, pre-Rockall scores and a composite endpoint (blood transfusion, endoscopic therapy, interventional radiology and surgery or 30-day mortality) were calculated. Results 388 patients with suspected UGIB were identified of which 92.3% were admitted (median (range) GBS = 5 (0–19) and Pre-Rockall = 2 (0–11)), representing 2.4% of 14,809 medical admissions. 7.7% were discharged (GBS = 0 (0–4) and Pre-Rockall = 0 (0–4)). 47.9% underwent endoscopy. 151 (38.9%) patients had the composite endpoint; of these, 77.5% received blood transfusion, 45.7% endoscopic treatment and 8.0% died within 30 days. AUROC (95% CI) for 30-day composite endpoint was 0.92 (0.89–0.94) using GBS and 0.75 (0.70–0.80) using pre-Rockall. Sensitivity, specificity, NPV and PPV for different GBS and pre-Rockall score thresholds are listed in table 1. Conclusion GBS is superior to pre-Rockall in predicting patients with UGIB who can be safely discharged. Sensitivity analysis suggests that patients with GBS