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News

Outpatient management of low-risk upper-GI bleeding

This week’s issue of the Lancet examines outpatient management of patients with low-risk upper-gastrointestinal hemorrhage.

News image

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Upper-gastrointestinal (GI) hemorrhage is a frequent reason for hospital admission.

 

Most risk scoring systems for this disorder incorporate endoscopic findings.

 

However, the Glasgow-Blatchford bleeding score (GBS) is based on simple clinical and laboratory variables.

 

A score of 0 identifies low-risk patients who might be suitable for outpatient management.

 

Dr Stanley and colleagues from the United Kingdom evaluated the Glasgow-Blatchford bleeding score, and the effect of a protocol based on this score for non-admission of low-risk individuals at 4 hospitals.

 

The team calculated the GBS, and pre-endoscopy and post-endoscopy Rockall scores for consecutive patients presenting with upper-gastrointestinal hemorrhage.

 

The team used receiver-operating characteristic curves to compare the ability of these scores to predict either need for clinical intervention or death.

 

The research team prospectively assessed at 2 hospitals the introduction of GBS scoring to avoid admission of low-risk patients.

22% with upper-gastrointestinal hemorrhage were classified as low risk

Lancet

 

Of 676 people presenting with upper-gastrointestinal hemorrhage, the team identified 16% who scored 0 on the GBS.

 

For prediction of need for intervention or death, GBS was superior to full Rockall score, which in turn was better than the admission Rockall score.

 

When introduced into clinical practice, 22% with upper-gastrointestinal hemorrhage were classified as low risk, of whom 68% were managed as outpatients without adverse events.

 

The team noted that the proportion of individuals with this condition admitted to hospital also fell from 96% to 71%.

 

Dr Stanley’s team concludes, “The GBS identifies many patients presenting to general hospitals with upper-gastrointestinal hemorrhage who can be managed safely as outpatients.”

 

“This score reduces admissions for this condition, allowing more appropriate use of in-patient resources.”

Lancet 2008: 373(9657): 42-7
06 January 2009

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