A Review of Risk Scores within Upper Gastrointestinal Bleeding

Josh Orpen-Palmer, Adrian J Stanley, Josh Orpen-Palmer, Adrian J Stanley

Abstract

Upper gastrointestinal bleeding is a common medical emergency. Thorough initial assessment and appropriate resuscitation are essential to stabilise the patient. Risk scores provide an important tool to discriminate between lower- and higher-risk patients. Very low-risk patients can be safely discharged for out-patient management, while higher-risk patients can receive appropriate in-patient care. The Glasgow Blatchford Score, with a score of 0-1, performs best in the identification of very low-risk patients who will not require hospital based intervention or die, and is recommended by most guidelines to facilitate safe out-patient management. The performance of risk scores in the identification of specific adverse events to define high-risk patients is less accurate, with no individual score performing consistently well. Ongoing developments in the use of machine learning models and artificial intelligence in predicting poor outcomes in UGIB appear promising and will likely form the basis of dynamic risk assessment in the future.

Keywords: acute gastrointestinal haemorrhage; non-variceal upper gastrointestinal bleeding; peptic ulcer bleeding; risk scores; risk stratification; variceal gastrointestinal bleeding.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of scoring systems in the prediction of 30-day mortality (n = 905). AUROC, area under receiver operating characteristic curve (95% CI); INBS, international new bleeding score; Pre-RS, pre-endoscopic Rockall score; GBS, Glasgow Blatchford score; PNED, Progetto Nazionale Emorragia Digestiva score. Note the INBS was subsequently renamed the ABC score by the authors [20].
Figure 2
Figure 2
Comparisons of scores in the prediction of a need for any intervention (transfusion, endoscopic treatment, interventional radiology or surgery) or 30-day mortality (n = 1704). All figures compared patients with complete data for all compared scores. AUROC—area under receiver operating characteristic curve [7].

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