Upper GI Bleeding, what's the risk?

The Resus Room

Patients frequently present to the Emergency Department either with direct concern following an upper gastro intestinal bleed, or with a history that points towards the diagnosis.

When these patients are haemodynamically unstable or with ongoing high volume bleeding the decision to admit or discharge becomes simple.

But when the episode has settled, deciding whether they are safe to be discharged and continue with outpatient follow up can be difficult. Lots of us use scoring systems such as the Glasgow-Batchford Score or the Rockall Score but how much do we actually understand regarding the 'positive' and 'negative' outcomes of those scores?

A recent paper on the topic helps to cast some light on the topic and forms the basis of this podcast.

One of the frequently used scoring systems is the Glasgow-Blatchford score below that bases it's score upon historical, physiological and laboratory findings.

mdcalc GBS scoring calculator

Probably the other most frequently used score in ED is the Rockall score, which in its full form utilises endoscopy findings, however for use in the ED (pre-endoscopy) it has been modified and utilised.

mdcalc pre-endoscopy Rockall Score

Have a listen to how these scores fare in the paper and it may inform your risk stratification in the ED.

Enjoy!

References and Further Reading

The Predictive Value of Pre-Endoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients with Upper Gastrointestinal Bleeding - A Systematic Review. Ramaekers R. Acad Emerg Med. 2016

Upper Gastro Intestinal Bleeding at St.Emlyn’s