Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
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Clin. Gastroenterol. Hepatol. · Jan 2015
Observational StudyPerformance of new thresholds of the Glasgow Blatchford score in managing patients with upper gastrointestinal bleeding.
Upper 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. ⋯ A 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%.
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Clin. Gastroenterol. Hepatol. · Jan 2015
Low likelihood of intracranial hemorrhage in patients with cirrhosis and altered mental status.
Given the myriad causes of altered mental status (AMS), patients with cirrhosis and hepatic encephalopathy often present a diagnostic dilemma. In light of the perceived bleeding tendency of patients with cirrhosis, intracranial hemorrhage (ICH) is often feared, so these patients frequently undergo non-contrast computed tomography (CT) of the head. However, little is known about the diagnostic yield of CT for patients with cirrhosis presenting with AMS. ⋯ Despite abnormal hemostatic indices, patients with cirrhosis presenting with AMS in the absence of focal neurologic deficits or trauma have a low likelihood of ICH.