Pre-Endoscopic Rockall and Blatchford Scores to Identify Which Emergency Department Patients with Suspected Gastrointestinal Bleed Do Not Need Endoscopic Hemostasis

• Published in: The Journal of emergency medicine 2013-06, Vol.44 (6), p.1083-1087
• Main Authors: Meltzer, Andrew C., MD, Burnett, Sarah, RN, BSN, Pinchbeck, Carrie, BS, Brown, Angela L., BS, Choudhri, Tina, MD, Yadav, Kabir, MS, MDCM, Fleischer, David E., MD, Pines, Jesse M., MD, MBA
• Format: Article
• Language: English
• Subjects: Adult; clinical decision rules; Decision Making; District of Columbia; Emergency; Emergency Department; Emergency medical services; Emergency Service, Hospital; endoscopy; Female; gastrointestinal; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - therapy; hemorrhage; Hemostasis, Endoscopic - statistics & numerical data; Humans; Male; Middle Aged; Patient Admission; Patient Selection; Retrospective Studies; Risk Assessment - methods
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2012.11.021

Abstract Background The pre-endoscopic Rockall Score (RS) and the Glasgow-Blatchford Scores (GBS) can help risk stratify patients with upper gastrointestinal bleed who are seen in the Emergency Department (ED). The RS and GBS have yet to be validated in a United States patient population for their ability to discriminate which ED patients with upper gastrointestinal bleed do not need endoscopic hemostasis. Objective We sought to determine whether patients who received a score of zero on either score (the lowest risk) in the ED still required upper endoscopic hemostasis during hospitalization. Methods Retrospective electronic medical record chart review was performed during a 3-year period (2007–2009) to identify patients with suspected upper gastrointestinal bleed by ED final diagnosis of gastrointestinal hemorrhage and related terms at a single urban academic ED. The RS and GBS were calculated from ED chart abstraction and the hospital records of admitted patients were queried for subsequent endoscopic hemostasis. Results Six hundred and ninety patients with gastrointestinal bleed were identified and 86% were admitted to the hospital. One hundred and twenty-two patients had an RS equal to zero; 67 (55%; 95% confidence interval [CI] 46–63%) of these patients were admitted to the hospital and 11 (16%; 95% CI 9–27%) received endoscopic hemostasis. Sixty-three patients had a GBS equal to zero; 15 (24%; 95% CI 15–36%) were admitted to the hospital and 2 (13%; 95% CI 4–38%) received endoscopic hemostasis. Conclusions Some patients who were identified as lowest risk by the GBS or RS still received endoscopic hemostasis during hospital admission. These clinical decision rules may be insufficiently sensitive to predict which patients do not require endoscopic hemostasis.