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Decision Rule of Corley et al for Adverse Outcome in Patients with Upper Gastrointestinal Hemorrhage Using Data Available at Initial Presentation

Purpose: To evaluate a patient with upper gastrointestinal (GI) bleeding for risk of adverse outcome using the decision rule of Corley et al.

Description

Corley et al developed a decision rule for patients with acute upper gastrointestinal bleeding based on data available at the time of initial presentation. This can help triage patients based on disease severity. The authors are from Brigham and Women's Hospital and the Harvard Medical School in Boston.


A good outcome was defined as all of the following:

(1) no evidence of persistent or recurrent rebleeding after initial stabilization

(2) not having an operation during the hospitalization

(3) being discharged alive

 

Parameters:

(1) initial hematocrit

(2) systolic blood pressure

(3) nasogastric lavage

(4) history of cirrhosis or ascites (evidence of portal hypertension)

(5) vomiting red blood

 

Parameter

Finding

Points

initial hematocrit

>= 30%

0

 

< 30%

1

systolic blood pressure

>= 100 mm Hg

0

 

< 100 mm Hg

1

nasogastric lavage

red blood absent

0

 

red blood present

1

history of cirrhosis or ascites

no

0

 

yes

1

vomited red blood

no

0

 

yes (hematemesis)

1

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 5

• The higher the score the higher the risk of adverse outcome.

• A patient with a score of 0 or 1 was classified as low risk for rebleeding.

• A patient with multiple risk factors was more likely to require endoscopic therapy to control the hemorrhage.

• The presence of comorbid conditions may increase the risk for complications.

 

Total Score

Percent with Rebleeding

0

9%

1

13%

2

34%

3

62%

4

71%

5

100%

 


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Specialty

Objective

ICD-10