Risk Stratification in Upper GI Bleeding

Mon, 10/14/2019 - 5:00am

Author:

Editor:

Patient presents with a history of dark stools for the past 2 days with no history of this before. The patient is hemodynamically stable and currently asymptomatic. FOBT is positive for occult blood, not grossly bloody. Is there an evidence based approach to risk stratify this patient for low risk upper GI bleeds?

Yes!

Glasgow-Blatchford Bleeding Score:

Initial Systolic Blood Pressure	≤109 mmHg
Heart Rate	≥ 100 bpm
Hemoglobin	<13 g/dl (male); <12 g/dl (female)
BUN	≥ 18.2 mg/dl
Melena Present?	Yes or No
Recent Syncope?	Yes or No
History of Hepatic Disease?	Yes or No
Cardiac Failure Present?	Yes or No

If any of the above are positive, score > 0, the patient requires further inpatient evaluation and endoscopy

If all are negative, the patient is appropriate for immediate outpatient GI evaluation and possible endoscopy

*As always, when using risk stratification tools, use clinical acumen when applying*

*We recommend you read some of the data behind these scoring systems yourself before using! See references below*

References:

- Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. The Lancet 2000;356:1318–21.

- Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patient with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007 Sep;25(7):774-9.

- Borbjerg Laursen et al. The Glasgow Blatchford Score Is the Most Accurate Assessment of Patients With Upper Gastrointestinal Hemorrhage. Clinical Gastroenterology and hepatology. 2012;10:1130–1135.