Patients with upper gastrointestinal hemorrhage may or may not need clinical intervention. A risk score based on clinical and laboratory findings can separate patients into low and high risk groups for needing intervention. The authors are from Glasgow in Scotland.
Parameters used for score:
(1) blood urea
(2) hemoglobin
(3) systolic blood pressure
(4) pulse
(5) presentation with melena
(6) presentation with syncope
(7) presence of hepatic disease
(8) presence of cardiac failure
|
Parameter |
Finding |
Points |
|
blood urea |
< 6.5 mmol/L |
0 |
|
|
6.5 to < 8.0 mmol/L |
2 |
|
|
8.0 to < 10.0 mmol/L |
3 |
|
|
10.0 to < 25.0 mmol/L |
4 |
|
|
>= 25 mmol/L |
6 |
|
hemoglobin in g/L |
>= 130 g/L in male |
0 |
|
|
120 to < 130 g/L in male |
1 |
|
|
100 to < 120 g/L in male |
3 |
|
|
<100 g/L in male |
6 |
|
|
>= 120 g/L in female |
0 |
|
|
100 to < 120 g/L in female |
1 |
|
|
< 100 g/L in female |
6 |
|
systolic blood pressure in mm Hg |
>= 110 mm Hg |
0 |
|
|
100 – 109 mm Hg |
1 |
|
|
90 – 99 mm Hg |
2 |
|
|
< 90 mm Hg |
3 |
|
pulse |
< 100 beats/minute |
0 |
|
|
>= 100 beats/minute |
1 |
|
melena present |
no |
0 |
|
|
yes |
1 |
|
syncope present |
no |
0 |
|
|
yes |
2 |
|
hepatic disease |
absent |
0 |
|
|
present |
2 |
|
heart failure |
absent |
0 |
|
|
present |
2 |
risk score =
= SUM(points for all 8 parameters)
|
Score |
Percent of Patients with Score Needing Intervention |
|
0 |
1.8% |
|
1 |
5.6% |
|
2 |
11.5% |
|
3 |
9% |
|
4 |
23.6% |
|
5 |
38% |
|
6 |
50% |
|
7 |
73% |
|
8 |
80% |
|
9 |
78% |
|
10 |
96% |
|
11 |
96% |
|
12 |
99% |
|
13 |
95% |
|
>= 14 |
100% |
based on data in Table 2, score development group, page 1319
Simplified "fast track" screening procedure: A person is at low risk of needing clinical intervention if all of the following are true:
(1) blood urea is < 6.5 mmol/L
(2) hemoglobin is > 130 g/L if male or > 120 g/L if female
(3) systolic blood pressure >= 110
(4) pulse < 100 beats per minute
Performance:
• The area under the ROC curve for separating patients: 0.92 (95% CI 0.88 – 0.95)
Purpose: To use the risk score of Blatchford et al to evaluate a patient with acute upper gastrointestinal hemorrhage.
Specialty: Gastroenterology
Objective: risk factors
ICD-10: K92.2,
