Gralnek et al selected factors identifying patients with peptic ulcer disease who are at low risk for complications. These patients can be discharged quickly from the hospital or managed as outpatients. The authors are from Technion Israel Institute of Technology in Haifa, McGill University, Centra Hospitalier Universitaire du Bocage and Universite de Bourgogne.
Parameters:
(1) age of the patient in years
(2) hemodynamic instability
(3) severe comorbid disease
(4) hemoglobin after adequate resuscitation
(5) need for blood transfusion
(6) coagulation studies
(7) location when peptic ulcer bleeding started
(8) endoscopic features of the peptic ulcer (early endoscopy performed within 24 hours after presentation)
(9) social support at home
(10) ability to return promptly to the hospital
|
Parameter |
Finding |
Points |
|
age of the patient in years |
< 60 years |
1 |
|
|
>= 60 years |
0 |
|
hemodynamic instability |
absent or stable within 3 hours of presentation |
1 |
|
|
present |
0 |
|
severe comorbid disease |
none |
1 |
|
|
1 or more |
0 |
|
hemoglobin after resuscitation |
>= 8 g/dL |
1 |
|
|
< 8 g/dL |
0 |
|
need for blood transfusion |
none |
1 |
|
|
1 or more units |
0 |
|
coagulation studies |
normal |
1 |
|
|
abnormal |
0 |
|
location when bleeding started |
outside hospital |
1 |
|
|
inside hospital |
0 |
|
endoscopic features |
ulcer with clean base or no obvious endoscopic findings |
1 |
|
|
neither of the above |
0 |
|
social support at home |
adequate |
1 |
|
|
inadequate |
0 |
|
able to return promptly |
able |
1 |
|
|
unable |
0 |
where:
• Severe comorbid diseases include: heart failure, renal failure, liver cirrhosis, stroke, hematologic malignancy, chronic obstructive pulmonary disease (COPD).
• Hemodynamic instability involves: resting tachycardia (pulse >= 100 beats per minute), systolic blood pressure < 100 mm Hg, or postural hypotension.
total score =
= SUM(points for the 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• A patient with a score of 10 can be discharged early from the hospital or treated as an outpatient.
Purpose: To identify a patient with a bleeding peptic ulcer who can be discharged early or managed as an outpatient based on the criteria of Gralnek et al.
Specialty: Gastroenterology, Infectious Diseases, Surgery, general
Objective: risk factors, criteria for diagnosis, selection
ICD-10: K27.4, I85.0,
