A prospective validation study of the Glasgow-Blatchford score
The utility of the Glasgow-Blatchford score in predicting clinical outcome and stratifying the need for therapeutic intervention in hospitalised patients with upper gastrointestinal bleeding: a prospective validating study.
Royal Adelaide Hospital
400 participants
Apr 5, 2015
Interventional
Conditions
Summary
The Glasgow-Blatchford score (GBS) has been shown to be superior to other scoring systems, such as the Rockall score, in predicting clinical outcomes and the need for endotherapy in hospitalised patients with upper gastrointestinal (UGI) bleeding. Specifically, our prospective observational study in 708 patients has recently found that a score of three or less identifies patients who do not require endoscopic intervention, blood transfusion, or surgery, and thus, could potentially be discharged early with conservative management and outpatient endoscopy. Despite the clinical implication of these findings, the use of the GBS in the management of UGI bleeding has not been adopted in practice at the Royal Adelaide Hospital. In order to further evaluate the use of the GBS to triage patients, we would like to prospectively validate the cut-off GBS of three or less in the outcome and management of patients with UGI haemorrhage (UGIH). More specifically, we would like to examine whether the GBS cut-off of three can determine the need for urgent endoscopy (within 24 hours), endotherapy, blood transfusion or surgery in these patients.
Eligibility
Inclusion Criteria1
- Two groups of hospitalised patients, aged greater than or equal to 18 years, who present to, or at, the Royal Adelaide Hospital for the management of UGIH. The first group of patients will be those presenting to the ED with a primary diagnosis of UGIH. The second group of patients will be inpatients who develop an UGIH during their admission at the Royal Adelaide Hospital. UGIH is defined as bleeding from the upper gastrointestinal tract as manifested by haematemesis (including coffee-ground vomiting) and/or melaena. Both variceal and non-variceal causes of UGIH will be included in the study.
Exclusion Criteria9
- Patients who are unable to give informed consent, and without the presence of a next of kin upon admission.
- Patients with urgent medical comorbidities, other than UGIH, which require inpatient admission.
- A known pre-existing cause of UGIH.
- Patients in whom outpatient follow-up cannot be guaranteed, including:
- a) Persons of no fixed address
- b) Rural and remote patients (only secondary outcomes can be measured, given that all patients in this category will be admitted)
- c) Patients with cognitive impairment
- d) Patients who live alone with inadequate adult supervision or social supports
- Pregnancy.
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Interventions
A prospective validation study of the Glasgow-Blatchford Score The Gastroenterology and Emergency Department (ED) will be informed of the proposed research project, in the form of an oral presentation by the Principal Investigators. Both departments will identify patients presenting with upper gastrointestinal bleeding in ED. In order to facilitate their decision making, potential participants will be given a patient information sheet and consent form. Flyers have been placed around ED for awareness of the study in the department. Patients who meet the inclusion criteria, either in the Emergency Department or on the wards, will be invited to participate in the study via telephone. After being consented with the consent form, those patients with a Glasgow-Blatchford Score (GBS) of three or less will be discharged, and an outpatient endoscopy within 2 weeks will be performed. If patients have a GBS of greater than 3, they will be admitted to the Royal Adelaide Hospital and an endoscopy will be performed at the hospital within 24 hours. In both cases, if therapeutic intervention is required, this treatment will also be carried out. Patients will also receive one long term follow up phone call.
Locations(1)
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ACTRN12617000654358