CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(10): E950-E958
DOI: 10.1055/s-0043-117880
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Glasgow Blatchford Score of limited benefit for low-risk urban patients: a mixed methods study

David A. Leiman1, Angela M. Mills2, Frances S. Shofer2, Andrew T. Weber3, Erin R. Leiman4, Brian P. Riff5, James D. Lewis6, Shivan J. Mehta6
  • 1Division of Gastroenterology, Duke University of School of Medicine, 2301 Erwin Road, Durham, NC, USA
  • 2Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania, United States
  • 3Department of Internal Medicine, Geffen School of Medicine at the University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, California, United States
  • 4Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States
  • 5Advanced Endoscopy Center, St. Jude Medical Center, Fullerton, California, United States
  • 6Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Further Information

Publication History

submitted 23 February 2017

accepted after revision 26 June 2017

Publication Date:
29 September 2017 (online)

Abstract

Background and study aims Most patients with upper gastrointestinal bleeding (UGIB) are hospitalized. Risk-stratifying UGIB with scoring tools may decrease avoidable admissions, thereby reducing the cost of care. We sought to describe how frequently low-risk UGIB patients present to urban emergency departments (ED) and the proportion who are admitted to examine how incorporating risk scores into decision support might diminish healthcare utilization in this population.

Patients and methods This is a retrospective cohort study of ED patients presenting from 2009 – 2013 to three urban hospitals that do not use electronic UGIB decision support. We used ED disposition diagnosis codes (ICD-9) to identify patients followed by manual chart review for verification and additional data collection. Patients with a Glasgow Blatchford Score (GBS) of 0 were classified as low risk. We also surveyed ED physicians at these hospitals to assess their beliefs about UGIB decision support.

Results Over the study period, 66 patients (13.2 per year) presented to the ED with low-risk UGIB. Of these, 10 patients (15.2 %) were admitted and none required endoscopic hemostasis. Most survey respondents (55.6 %, n = 20) were aware of UGIB risk scores but a minority (19.4 %, n = 7) used one.

Conclusions Low-risk UGIB patients infrequently present to the ED and only a minority are admitted. Despite advocacy to incorporate decision support into routine clinical care, ED physicians independently identified low risk patients. There is insufficient evidence to suggest the magnitude of this problem is large enough to warrant implementation of decision support for low risk UGIB.