Imperial College London
Alternate

DrLakshmanaAyaru

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Honorary Senior Clinical Lecturer
 
 
 
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Contact

 

l.ayaru

 
 
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Location

 

Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Banister:2018:10.1136/bmjgast-2018-000225,
author = {Banister, T and Spiking, J and Ayaru, L},
doi = {10.1136/bmjgast-2018-000225},
journal = {BMJ Open Gastroenterology},
title = {Discharge of patients with an acute upper gastrointestinal bleed from the emergency department using an extended Glasgow Blatchford Score},
url = {http://dx.doi.org/10.1136/bmjgast-2018-000225},
volume = {5},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective To use an extended Glasgow-Blatchford Score (GBS) cut-off of ≤1 to aid discharge of patients presenting with acute upper gastrointestinal bleeding (AUGIB) from emergency departments.Background The GBS accurately predicts the need for intervention and death in AUGIB, and a cut-off of 0 is recommended to identify patients for discharge without endoscopy. However, this cut-off is limited by identifying a low percentage of low-risk patients. Extension of the cut-off to ≤1 or ≤2 has been proposed to increase this proportion, but there is controversy as to the optimal cut-off and little data on performance in routine clinical practice.Methods Dual-centre study in which patients with AUGIB and GBS ≤1 were discharged from the emergency department without endoscopy unless there was another reason for admission. Retrospective analysis of associated adverse outcome defined as a 30-day combined endpoint of blood transfusion, intervention or death.Results 569 patients presented with AUGIB from 2015 to 2018. 146 (25.7%) had a GBS ≤1 (70, GBS=0; 76, GBS=1). Of these, 103 (70.5%) were managed as outpatients, and none had an adverse outcome. GBS ≤1 had a negative predictive value=100% and the GBS had an area under receiver operator characteristic (AUROC)=0.89 (95% CI 0.86 to 0.91) in predicting adverse outcomes. In 2008–2009, prior to risk scoring (n=432), 6.5% of patients presenting with AUGIB were discharged safely from the emergency department in comparison with 18.1% (p<0.001) in this cohort. A GBS cut-off ≤2 was associated with an adverse outcome in 8% of cases.Conclusion GBS of ≤1 is the optimal cut-off for the discharge of patients with an AUGIB from the emergency department.
AU  - Banister,T
AU  - Spiking,J
AU  - Ayaru,L
DO  - 10.1136/bmjgast-2018-000225
PY  - 2018///
SN  - 2054-4774
TI  - Discharge of patients with an acute upper gastrointestinal bleed from the emergency department using an extended Glasgow Blatchford Score
T2  - BMJ Open Gastroenterology
UR  - http://dx.doi.org/10.1136/bmjgast-2018-000225
UR  - http://hdl.handle.net/10044/1/62964
VL  - 5
ER  -
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