• Gac Med Mex · Jan 2020

    Upper gastrointestinal hemorrhage re-bleeding risk according to the Glasgow-Blatchford scale: a triage tool.

    • Miroslava Olivarec-Bonilla, Anaidt M García-Montano, and Armando Herrera-Arellano.
    • Adult Emergency Department, No. 1 Regional General Hospital, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos.
    • Gac Med Mex. 2020 Jan 1; 156 (6): 493-498.

    IntroductionThe Glasgow-Blatchford scale (GBS) classifies the risk of re-bleeding after upper gastrointestinal bleeding (UGIB) using clinical data, whereas the Forrest and Dagradi scales do it by endoscopy.ObjectiveTo assess GBS's ability to identify re-bleeding risk within 30 days of an UGIB, using endoscopy as the gold standard for comparison.Method129 medical records of patients with UGIB and endoscopy were analyzed. The Glasgow-Blatchford, Forrest and Dagradi scales were quantified; sensitivity, specificity and area under the ROC curve (AUC-ROC) of GBS-reported re-bleeding risk were calculated.ResultsGBS identified 53 patients with low re-bleeding risk (41.09 %) and 76 with high risk (58.91 %). Endoscopy identified 107 patients with non-variceal bleeding (82.94 %): 98 with low risk (89.9 %) and 11 with high risk (10.09 %); in addition, it identified 22 patients with variceal hemorrhage (17.05 %): 12 with low risk (54.54 %) and 10 with high risk (45.45 %). GBS showed a sensitivity of 0.857, specificity of 0.462 and an AUC-ROC of 0.660.ConclusionsGBS is simple, objective and useful to identify the risk of re-bleeding after UGIB; it is suggested as a triage tool in the emergency department.IntroducciónCon la escala de Glasgow-Blatchford (EG-B) se califica mediante datos clínicos, el riesgo de resangrado después de hemorragia del tubo digestivo alto (HTDA); y con las escalas de Forrest y Dagradi, mediante endoscopia.ObjetivoEvaluar la capacidad de la EG-B para identificar riesgo de resangrado a 30 días después de una HTDA; el estándar de oro de comparación fue la endoscopia.MétodoSe analizaron 129 expedientes de pacientes con HTDA y endoscopia. Se cuantificaron las escalas de Glasgow-Blatchford, Forrest y Dagradi; se calculó sensibilidad, especificidad y área bajo la curva ROC (ABC-ROC) del riesgo de resangrado reportado por EG-B.ResultadosLa EG-B identificó a 53 pacientes con riesgo bajo de resangrado (41.09 %) y 76 con riesgo alto (58.91 %). Con la endoscopia se identificó a 107 pacientes con hemorragia no variceal (82.94 %), 98 con riesgo bajo (89.9 %) y 11 con riesgo alto (10.09 %); además, 22 pacientes con hemorragia variceal (17.05 %), 12 con riesgo bajo (54.54 %) y 10 con riesgo alto (45.45 %). La EG-B mostró sensibilidad de 0.857, especificidad de 0.462 y ABC-ROC de 0.660.ConclusionesLa EG-B es sencilla, objetiva y útil para identificar riesgo de resangrado después de HTDA; se sugiere como herramienta de triaje en urgencias.Copyright: © 2020 Permanyer.

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