Prospective validation of the glasgow blatchford scoring system in patients with upper gastrointestinal bleeding in the emergency department

Abstract

Background/aims: This study aimed to allow decision-making about hospitalization or discharge using the Glasgow Blatchford Scoring system, a risk analysis performed using basic laboratory and clinical variables, in patients presenting to the Emergency Department with upper gastrointestinal system bleeding. Materials and Methods: This prospective, observational study conducted in the Emergency Department of a university hospital enrolled patients aged >= 18 years, who presented to the Emergency Department with upper gastrointestinal system bleeding between June 2009 and December 2010. For all patients, Glasgow Blatchford Scoring scores were calculated, and the patients were classified into two groups as high-risk and low-risk patients. Results: A total of 160 subjects with upper gastrointestinal system bleeding were enrolled in the study. Mean Glasgow Blatchford Scoring scores were 7.1 +/- 3.8 for 71 low-risk subjects and 11.7 +/- 2.9 for 89 high-risk subjects, and the difference between the two groups was statistically significant (p<0.001). When the performance of the Glasgow Blatchford Scoring system was evaluated in the determination of high risk, the sensitivity and specificity were 100% and 1.41%, respectively, for a cut-off value of Glasgow Blatchford Scoring >0, 100% and 16.9% for a cut-off value of Glasgow Blatchford Scoring >3, 96.63% and 36.62% for a cut-off value of Glasgow Blatchford Scoring >5, and 86.52% and 69.01% for a cut-off value of Glasgow Blatchford Scoring >8. In the receiver operating characteristic curve analysis, for Glasgow Blatchford Scoring in the high-risk estimation, the area under the curve was found to be 0.82 (95% CI: 0.75-0.88), and this value was statistically significant (p=0.0001). Conclusions: The Glasgow Blatchford Scoring system, which may be easily calculated based on laboratory and clinical variables, seems to be a useful scoring system for risk analysis of all patients with upper gastrointestinal system bleeding admitted to the Emergency Department.