Clason et al evaluated risk factors associated with further hemorrhage or mortality in a patient presenting with upper gastrointestinal (GI) hemorrhage. This can help identify patients who may benefit from more aggressive management and monitoring. The scores appear to antedate the Rockall score (see above). The authors are from Bangour General Hospital in West Lothian and the University of Edinburgh.
Parameters:
(1) age
(2) admission hemoglobin
(3) chief complaint on admission
(4) endoscopic stigmata of recent hemorrhage from a peptic ulcer
(5) clinical shock
(6) episode of further hemorrhage
Criteria for further hemorrhage - one of the following:
(1) after initial resuscitation, continued clinical evidence of blood loss (hematemesis, melena) requiring blood transfusion
(2) after a period with no evidence of bleeding the patient:
(2a) vomits or has nasogastric return of bright red blood and
(2b) has evidence of hypovolemic shock or rapidly progressive anemia
|
Parameter |
Finding |
Point for Hemorrhage |
Point for Mortality |
|
age |
<= 60 years |
0 |
0 |
|
|
> 60 years |
1 |
1 |
|
admission hemoglobin |
>= 8 g/dL |
0 |
NA |
|
|
< 8 g/dL |
1 |
NA |
|
chief complaint |
hematemesis |
1 |
NA |
|
|
other |
0 |
NA |
|
endoscopic stigmata |
none |
0 |
NA |
|
|
present |
1 |
NA |
|
clinical shock |
absent |
NA |
0 |
|
|
present |
NA |
1 |
|
further hemorrhage |
absent |
NA |
0 |
|
|
present |
NA |
1 |
risk score for further hemorrhage =
= SUM(points for 4 applicable risk factors)
risk score for mortality =
= SUM(points for 3 applicable risk factors)
Interpretation:
• minimum risk score: 0
• maximum score for risk of further hemorrhage: 4
• maximum score for risk of mortality: 3
|
Score for Further Hemorrhage |
Percent Further Hemorrhage |
|
0 |
10% |
|
1 |
11% |
|
2 |
35% |
|
3 |
62% |
|
4 |
71% |
from Table 5, page 986
|
Score for Mortality |
Percent Mortality |
|
0 |
1% |
|
1 |
3% |
|
2 |
25% |
|
3 |
60% |
from Table 6, page 986
Limitations:
• The probabilities are those for 1987, prior to several advances in management of upper GI hemorrhage.
• One assumption is that the hemoglobin < 8.0 g/dL is due to the upper GI hemorrhage. A patient may have more than one reason for anemia and the physiologic effect of acute bleeding is different from that of chronic anemia.
Specialty: Gastroenterology
