Robins et al identified criteria for selecting a patient with acute upper gastrointestinal bleeding who are low risk and who can be observed without endoscopy. The authors are from St. James's University Hospital (Leeds), Victoria Infirmary (Glasgow) and Leeds General Infirmary.
Patient: acute upper gastrointestinal bleeding
Outcome: discharge within 24 hours, observation without endoscopy
Parameters:
(1) Blatchford score
(2) age in years
(3) postural drop in systolic blood pressure in mm Hg
(4) known to have esophageal varices
(5) anticoagulation therapy
(6) social circumstances permissive of early discharge
|
Parameter
|
Finding
|
Points
|
|
Blatchford score
|
0 or 1
|
1
|
|
|
>= 2
|
0
|
|
age in years
|
< 60 years
|
1
|
|
|
>= 60 years
|
0
|
|
postural drop in BP
|
<= 20 mm Hg
|
1
|
|
|
> 20 mm Hg
|
0
|
|
esophageal varices
|
none known
|
1
|
|
|
known present
|
0
|
|
anticoagulation therapy
|
no
|
1
|
|
|
yes
|
0
|
|
social circumstances
|
no
|
0
|
|
|
yes
|
1
|
number of favorable factors =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• A patient with a score of 6 can be observed and discharged within 24 hours.
• Early discharge requires the ability of the patient to return if rebleeding recurs.
• A key requirement is adequate discharge planning with confirmed follow-up.
