Which Scoring System Best Predicts Outcomes of Upper Gastrointestinal Bleeding?
Glasgow-Blatchford and Rockall scores were similarly effective, but comparing systems is less important than using some method to identify which patients need early and vigorous therapy.
Multiple studies have evaluated various scoring systems to predict the outcome of patients with nonvariceal upper gastrointestinal bleeding (UGIB). Recent comparisons between Rockall scores — including both pre-endoscopy scores and postendoscopy (complete) scores — and the Glasgow-Blatchford score (GBS), which does not require endoscopy, have suggested that these three scores all have predictive value.
To further compare the ability of these scores to predict outcomes, investigators prospectively collected data from patients who presented with UGIB at four hospitals in the U.K. Some data were collected retrospectively from one hospital. Therapy was provided according to existing guidelines but varied somewhat when different protocols were used at some hospitals.
Of 1555 patients, 4.8% died, 14.3% underwent endoscopic or surgical intervention, and 23.3% required transfusion. All three scores were able to identify patients who ultimately died: The areas under the receiver operating characteristic curve (AUROC) for GBS, pre-endoscopy Rockall score, and complete Rockall score were 0.741, 0.764, and 0.790, respectively. The GBS and complete Rockall scores demonstrated similar ability to predict the need for endoscopic or surgical therapy (AUROC, 0.793 and 0.764, respectively); both were superior in that respect to the pre-endoscopy Rockall score (AUROC, 0.630). The GBS was better able to predict the need for transfusion (AUROC, 0.919) than were the pre-endoscopy and complete Rockall scores (AUROC, 0.690 and 0.752, respectively).
Citation(s):Stanley AJ et al. Multicentre comparison of the Glasgow Blatchford and Rockall scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage. Aliment Pharmacol Ther 2011 Aug; 34:470.
