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 22 November 2017

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The incremental value of upper endoscopy in the identification of patients with non-variceal upper-GI hemorrhage

Writing in the July issue of Gastrointestinal Endoscopy, scientists have compared an endoscopy-based risk score with two clinically based risk scores to quantify the incremental value of endoscopy in the identification of low-risk bleeding in patients undergoing treatment for acute upper-GI hemorrhage.

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Doctors Ian M. Gralnek and Gareth S. Dulai, studied a cohort of 175 patients hospitalized with acute non-variceal upper-GI hemorrhage.

They were interested to learn whether risk scores for triage of such patients that incorporate endoscopic variables, such as the complete Rockall Score, may have better test characteristics for identification of "low-risk" bleeding episodes than risk scores that rely on clinical variables only (for example the Blatchford Score or the clinical Rockall Score).

The researchers used two data abstractors who were blinded to the aims of the study to gather medical record data on the patients enrolled in the study, using a standardized data collection protocol.

The endoscopy-based score identified more low risk patients than the clinical-based risk scores
Gastrointestinal Endoscopy

Blatchford and Rockall Scores were then generated from this information for each of the patients.

A Blatchford Score of 0 was defined as low risk, as was a clinical Rockall Score of 0, or a complete Rockall Score of 2 or less.

Using these definitions, only 14 of 175 patients (8%) were identified as low risk using the Blatchford Score.

This compared to 12% of patients with acute, non-variceal upper-GI hemorrhages that were classed as low risk according to the clinical Rockall Score.

This was still low when compared to the complete Rockall Score, which identified 53 of 175 patients (30%) as low risk cases.

Commenting on their findings, the research group said that the complete Rockall Score identified significantly more low-risk patients with acute upper-GI hemorrhage than either the clinical Rockall Score or the Blatchford Score.

They add that, "Identification of additional low-risk patients via this endoscopy-based score could lead to decreases in the use of hospital-based services, iatrogenic complications, and time lost from work or usual activity, while improving quality of care."

"Use of the clinical and complete Rockall Scores sequentially, with consideration of outpatient care for patients identified as low risk, is recommended", they conclude.

Gastrointest Endosc 2004; 60 (1): 9
07 July 2004

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