Clinical Performance of Prediction Rules and Nasogastric Lavage for the Evaluation of Upper Gastrointestinal Bleeding: A Retrospective Observational Study.

Published

Journal Article

Introduction. The majority of patients with acute upper gastrointestinal bleeding (UGIB) are admitted for urgent endoscopy as it can be difficult to determine who can be safely managed as an outpatient. Our objective was to compare four clinical prediction scoring systems: Glasgow Blatchford Score (GBS) and Clinical Rockall, Adamopoulos, and Tammaro scores in a sample of patients presenting to the emergency department of a large US academic center. Methods. We performed a retrospective cohort study of patients during 2008-2010. Our outcome was significant UGIB defined as high-risk stigmata on endoscopy, or receipt of blood transfusion or surgery, or death. Results. A total of 393 patients met inclusion criteria. The GBS was the most sensitive for detecting significant UGIB at 98.30% and had the highest negative predictive value (90.00%). Adding nasogastric lavage data to the GBS increased the sensitivity to 99.57%. Conclusions. Of all four scoring systems compared, the GBS demonstrated the highest sensitivity and negative predictive value for identifying a patient with a significant UGIB. Therefore, patients with a 0 score can be safely managed as an outpatient. Our results also suggest that performing a nasogastric lavage adds little to the diagnosis UGIB.

Full Text

Duke Authors

Cited Authors

  • Dakik, HK; Srygley, FD; Chiu, S-T; Chow, S-C; Fisher, DA

Published Date

  • January 26, 2017

Published In

Volume / Issue

  • 2017 /

Start / End Page

  • 3171697 -

PubMed ID

  • 28246528

Pubmed Central ID

  • 28246528

Electronic International Standard Serial Number (EISSN)

  • 1687-630X

International Standard Serial Number (ISSN)

  • 1687-6121

Digital Object Identifier (DOI)

  • 10.1155/2017/3171697

Language

  • eng