• Stig B Laursen, Harry R Dalton, Iain A Murray, Nick Michell, Matt R Johnston, Michael Schultz, Jane M Hansen, Ove B Schaffalitzky de Muckadell, Oliver Blatchford, Adrian J Stanley, and Upper Gastrointestinal Hemorrhage International Consortium.
• Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark. Electronic address: stig.borbjerg.laursen@ouh.regionsyddanmark.dk.
• Clin. Gastroenterol. Hepatol. 2015 Jan 1;13(1):115-21.e2.

Background & AimsUpper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could be managed as outpatients. Some investigators therefore have proposed extending the definition of low-risk patients by using a higher GBS cut-off value, possibly with an age adjustment. We compared 3 thresholds of the GBS and 2 age-adjusted modifications to identify the optimal cut-off value or modification.MethodsWe performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients identified, and outcomes of patients classified as low risk.ResultsThere were differences in age (P = .0001), need for intervention (P < .0001), mortality (P < .015), and GBS (P = .0001) among sites. All systems identified low-risk patients with high levels of sensitivity (>97%). The GBS at cut-off values of ≤1 and ≤2, and both modifications, identified low-risk patients with higher levels of specificity (40%-49%) than the GBS with a cut-off value of 0 (22% specificity; P < .001). The GBS at a cut-off value of ≤2 had the highest specificity, but 3% of patients classified as low-risk patients had adverse outcomes. All GBS cut-off values, and score modifications, had low levels of specificity when tested in New Zealand (2.5%-11%).ConclusionsA GBS cut-off value of ≤1 and both GBS modifications identify almost twice as many low-risk patients with UGIH as a GBS at a cut-off value of 0. Implementing a protocol for outpatient management, based on one of these scores, could reduce hospital admissions by 15% to 20%.Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

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