Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding

Stig B Laursen; Harry R Dalton; Iain A Murray; Nick Michell; Matt R Johnston; Michael Schultz; Jane M Hansen; Ove B Schaffalitzky de Muckadell; Oliver Blatchford; Adrian J Stanley; Upper Gastrointestinal Hemorrhage International Consortium

doi:10.1016/j.cgh.2014.07.023

Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding

Stig B Laursen, Harry R Dalton, Iain A Murray, Nick Michell, Matt R Johnston, Michael Schultz, Jane M Hansen, Ove B Schaffalitzky de Muckadell, Oliver Blatchford, Adrian J Stanley, Upper Gastrointestinal Hemorrhage International Consortium

KI, OUH, Forskningsenhed for Medicinsk gastroenterologi (Odense)

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

BACKGROUND & AIMS: Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could be managed as outpatients. Some investigators therefore have proposed extending the definition of low-risk patients by using a higher GBS cut-off value, possibly with an age adjustment. We compared 3 thresholds of the GBS and 2 age-adjusted modifications to identify the optimal cut-off value or modification.

METHODS: We performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients identified, and outcomes of patients classified as low risk.

RESULTS: There were differences in age (P = .0001), need for intervention (P < .0001), mortality (P < .015), and GBS (P = .0001) among sites. All systems identified low-risk patients with high levels of sensitivity (>97%). The GBS at cut-off values of ≤1 and ≤2, and both modifications, identified low-risk patients with higher levels of specificity (40%-49%) than the GBS with a cut-off value of 0 (22% specificity; P < .001). The GBS at a cut-off value of ≤2 had the highest specificity, but 3% of patients classified as low-risk patients had adverse outcomes. All GBS cut-off values, and score modifications, had low levels of specificity when tested in New Zealand (2.5%-11%).

CONCLUSIONS: A GBS cut-off value of ≤1 and both GBS modifications identify almost twice as many low-risk patients with UGIH as a GBS at a cut-off value of 0. Implementing a protocol for outpatient management, based on one of these scores, could reduce hospital admissions by 15% to 20%.

Originalsprog	Engelsk
Tidsskrift	Clinical Gastroenterology and Hepatology
Vol/bind	13
Udgave nummer	1
Sider (fra-til)	115-121.e2
ISSN	1542-3565
DOI	https://doi.org/10.1016/j.cgh.2014.07.023
Status	Udgivet - 1. jan. 2015

Dokumenter og links

10.1016/j.cgh.2014.07.023

Citationsformater

Laursen, S. B., Dalton, H. R., Murray, I. A., Michell, N., Johnston, M. R., Schultz, M., Hansen, J. M., Schaffalitzky de Muckadell, O. B., Blatchford, O., Stanley, A. J., & Upper Gastrointestinal Hemorrhage International Consortium (2015). Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding. Clinical Gastroenterology and Hepatology, 13(1), 115-121.e2. https://doi.org/10.1016/j.cgh.2014.07.023

@article{12114b9559234836b65e07bed44ddbad,

title = "Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding",

abstract = "BACKGROUND & AIMS: Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could be managed as outpatients. Some investigators therefore have proposed extending the definition of low-risk patients by using a higher GBS cut-off value, possibly with an age adjustment. We compared 3 thresholds of the GBS and 2 age-adjusted modifications to identify the optimal cut-off value or modification.METHODS: We performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients identified, and outcomes of patients classified as low risk.RESULTS: There were differences in age (P = .0001), need for intervention (P < .0001), mortality (P < .015), and GBS (P = .0001) among sites. All systems identified low-risk patients with high levels of sensitivity (>97%). The GBS at cut-off values of ≤1 and ≤2, and both modifications, identified low-risk patients with higher levels of specificity (40%-49%) than the GBS with a cut-off value of 0 (22% specificity; P < .001). The GBS at a cut-off value of ≤2 had the highest specificity, but 3% of patients classified as low-risk patients had adverse outcomes. All GBS cut-off values, and score modifications, had low levels of specificity when tested in New Zealand (2.5%-11%).CONCLUSIONS: A GBS cut-off value of ≤1 and both GBS modifications identify almost twice as many low-risk patients with UGIH as a GBS at a cut-off value of 0. Implementing a protocol for outpatient management, based on one of these scores, could reduce hospital admissions by 15% to 20%.",

keywords = "Gastrointestinal bleeding, Management, Outpatient, Prognosis, UGIH",

author = "Laursen, {Stig B} and Dalton, {Harry R} and Murray, {Iain A} and Nick Michell and Johnston, {Matt R} and Michael Schultz and Hansen, {Jane M} and {Schaffalitzky de Muckadell}, {Ove B} and Oliver Blatchford and Stanley, {Adrian J} and {Upper Gastrointestinal Hemorrhage International Consortium}",

year = "2015",

month = jan,

day = "1",

doi = "10.1016/j.cgh.2014.07.023",

language = "English",

volume = "13",

pages = "115--121.e2",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders",

number = "1",

}

Laursen, SB, Dalton, HR, Murray, IA, Michell, N, Johnston, MR, Schultz, M, Hansen, JM, Schaffalitzky de Muckadell, OB, Blatchford, O, Stanley, AJ & Upper Gastrointestinal Hemorrhage International Consortium 2015, 'Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding', Clinical Gastroenterology and Hepatology, bind 13, nr. 1, s. 115-121.e2. https://doi.org/10.1016/j.cgh.2014.07.023

TY - JOUR

T1 - Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding

AU - Laursen, Stig B

AU - Dalton, Harry R

AU - Murray, Iain A

AU - Michell, Nick

AU - Johnston, Matt R

AU - Schultz, Michael

AU - Hansen, Jane M

AU - Schaffalitzky de Muckadell, Ove B

AU - Blatchford, Oliver

AU - Stanley, Adrian J

AU - Upper Gastrointestinal Hemorrhage International Consortium

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND & AIMS: Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could be managed as outpatients. Some investigators therefore have proposed extending the definition of low-risk patients by using a higher GBS cut-off value, possibly with an age adjustment. We compared 3 thresholds of the GBS and 2 age-adjusted modifications to identify the optimal cut-off value or modification.METHODS: We performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients identified, and outcomes of patients classified as low risk.RESULTS: There were differences in age (P = .0001), need for intervention (P < .0001), mortality (P < .015), and GBS (P = .0001) among sites. All systems identified low-risk patients with high levels of sensitivity (>97%). The GBS at cut-off values of ≤1 and ≤2, and both modifications, identified low-risk patients with higher levels of specificity (40%-49%) than the GBS with a cut-off value of 0 (22% specificity; P < .001). The GBS at a cut-off value of ≤2 had the highest specificity, but 3% of patients classified as low-risk patients had adverse outcomes. All GBS cut-off values, and score modifications, had low levels of specificity when tested in New Zealand (2.5%-11%).CONCLUSIONS: A GBS cut-off value of ≤1 and both GBS modifications identify almost twice as many low-risk patients with UGIH as a GBS at a cut-off value of 0. Implementing a protocol for outpatient management, based on one of these scores, could reduce hospital admissions by 15% to 20%.

AB - BACKGROUND & AIMS: Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could be managed as outpatients. Some investigators therefore have proposed extending the definition of low-risk patients by using a higher GBS cut-off value, possibly with an age adjustment. We compared 3 thresholds of the GBS and 2 age-adjusted modifications to identify the optimal cut-off value or modification.METHODS: We performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients identified, and outcomes of patients classified as low risk.RESULTS: There were differences in age (P = .0001), need for intervention (P < .0001), mortality (P < .015), and GBS (P = .0001) among sites. All systems identified low-risk patients with high levels of sensitivity (>97%). The GBS at cut-off values of ≤1 and ≤2, and both modifications, identified low-risk patients with higher levels of specificity (40%-49%) than the GBS with a cut-off value of 0 (22% specificity; P < .001). The GBS at a cut-off value of ≤2 had the highest specificity, but 3% of patients classified as low-risk patients had adverse outcomes. All GBS cut-off values, and score modifications, had low levels of specificity when tested in New Zealand (2.5%-11%).CONCLUSIONS: A GBS cut-off value of ≤1 and both GBS modifications identify almost twice as many low-risk patients with UGIH as a GBS at a cut-off value of 0. Implementing a protocol for outpatient management, based on one of these scores, could reduce hospital admissions by 15% to 20%.

KW - Gastrointestinal bleeding

KW - Management

KW - Outpatient

KW - Prognosis

KW - UGIH

U2 - 10.1016/j.cgh.2014.07.023

DO - 10.1016/j.cgh.2014.07.023

M3 - Journal article

C2 - 25058843

SN - 1542-3565

VL - 13

SP - 115-121.e2

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 1

ER -

Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding

Abstract

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