Upper gastrointestinal bleeding Microchapters |
Differentiating Upper Gastrointestinal Bleeding from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Two scoring systems identify those at risk for adverse outcomes from UGIB which include Glasgow Blatchford Score (GBS) and Rockall score. Glasgow Blatchford score is most commonly used and is more accurate.
Two scoring systems identify those at risk for adverse outcomes from UGIB:[1]
GBS is the more effective system for predicting the need for transfusion in patients with UGIB:
The Glasgow Blatchford Score (GBS) | |||
---|---|---|---|
Admission risk markers | Score | ||
Blood urea nitrogen level (mg/dl) | ≥ 18.2 to < 22.4 | 2 | |
≥ 22.4 to < 28 | 3 | ||
≥ 28 to < 70 | 4 | ||
≥ 70 | 6 | ||
Hemoglobin level (g/dl) | Men | ≥ 12 to < 13 | 1 |
≥ 10 to < 12 | 3 | ||
< 10 | 6 | ||
Women | ≥ 10 to < 12 | 1 | |
< 10 | 6 | ||
Systolic blood pressure (mmHg) | ≥ 100 to < 109 | 1 | |
≥ 90 to < 99 | 2 | ||
< 90 | 3 | ||
Other markers | Pulse rate ≥ 100 beats/min | 1 | |
Presentation with melena | 1 | ||
Presentation with syncope | 2 | ||
Hepatic disease | 2 | ||
Heart failure | 2 | ||
Interpratation of score | 0-2 | Low-risk group | |
>6 | High risk group |
The complete Rockall score identifies those patients with evidence of acute UGIB on endoscopy who are at low risk for further bleeding or death.[4][5]
The Rockall score | |||
---|---|---|---|
Markers | Score | ||
Age | <60 | 0 | |
60 - 79 | 1 | ||
≥ 80 | 2 | ||
Shock stage | Blood pressure | >120 | 0 |
100-119 | 1 | ||
<100 | 2 | ||
Heart rate | >100 | 0 | |
<100 | 1 | ||
Comorbidity | No major comorbidity | 0 | |
Cardiac failure
Any major comorbidity |
2 | ||
Renal failure
Disseminated malignancy |
3 | ||
Diagnosis | Mallory-Weiss tear, no lesion identified and no SRH | 0 | |
All other diagnosis | 1 | ||
Malignancy of upper GI tract | 2 | ||
Major SRH | None or dark spot only | 0 | |
Blood in upper GI tract, adherent clot, visible or spurting vessel |
2 | ||
Interpratation of score
(Range of score is 0-11) |
Score of ≤ 3 | Low mortality risk | |
Score of ≥ 8 | High mortality risk | ||
GI: Gastrointestinal, SRH: Signs of recent hemorrhage |