Which to risk-stratifying tools are used in the workup of upper gastrointestinal bleeding (UGIB)?

Updated: Aug 12, 2019
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

Many tools are used to stratify the severity of bleeding in patients presenting with an acute upper gastrointestinal (GI) bleed (UGIB). Several use the blood urea nitrogen (BUN) or the BUN-to-creatinine ratio as part of the formula when calculating the bleeding risk. The primary goals are to identify those who are at high risk for severe bleeding that requires hospital admission, the necessity of endoscopic intervention, the need for triage to intensive care unit (ICU) admission, the risk for rebleeding, and mortality. [101, 102]

The modified Glasgow-Blatchford bleeding score (GBS) and the Rockall bleeding score are the two systems most commonly used for estimating in-hospital mortality in UGIB. These tools utilize both pre- and post-endoscopy components for scoring. The GBS score helps to identify patients at lower risk for severe bleeding and who might be managed as an outpatient. The Rockall score and the more recent AIMS65 score (lbumin < 3.0 g/dL, nternational normalized ratio [INR] >1.5, altered ental status, ystolic blood pressure ≤90 mm Hg, and age >65  y), [189, 187, 188]  reliably predict mortality. [103]

The Progetto Nazionale Emorragia Digestiva (PNED) system, a very complex and relatively new tool, is thought to not only be more selective for classifying a case as severe but also to have a greater predictive capacity for mortality compared with the Rockall score. [104]

Each of these tools is becoming a common component in the risk-stratifying process in current practice for assessing the severity of GI bleeding, triage, and role for endoscopic intervention. [187, 188, 105]


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