Kollef et al developed a simple classification tool to triage patients with acute gastrointestinal hemorrhage admitted to the Intensive Care Unit (ICU). This can help distinguish low and high risk patients. The authors are from Washington University in St. Louis.
NOTE: The tool applies to patients with acute upper or lower gastrointestinal hemorrhage.
Parameters:
(1) hemodynamically stability on admission to the ICU
(2) requirement for vasopressors
(3) other organ system failures
(4) evidence of active, on-going gastrointestinal hemorrhage at time of triage
A patient is considered hemodynamically stable if both the following are present:
(1) mean arterial pressure > 60 mm Hg
(2) systolic blood pressure > 100 mm Hg
An organ failure for a body system is a disease that usually requires intensive care (such as acute myocardial infarction, major stroke, liver failure, renal failure, etc.).
Active on-going gastrointestinal bleeding involves one or more of the following:
(1) blood red hematemesis
(2) blood red nasogastric lavage
(3) bright red blood per rectum (not due to hemorrhoids)
Parameter |
Finding |
Points |
hemodynamic stability |
stable |
0 |
|
unstable |
1 |
vasopressors |
not required |
0 |
|
required |
1 |
other organ failures |
absent |
0 |
|
present |
1 |
active GI bleeding |
absent |
0 |
|
present |
1 |
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• A patient is classified as low risk if the score is 0, else classified high risk (scores 1 to 3).
Specialty: Gastroenterology