send your upper GI bleeder home?

20 Nov

2009 study by Stanley et al:

used a decision rule based on clinical and lab values (Glascow-Blatchford bleeding score)

study of 676 people with upper GIB: 105 (16%) had a score of ZERO

 

score of ZERO identified low-risk patients who might be suitable for outpatient management

  • i.e. GBS of ZERO have low risk (0.5%) of needing intervention (transfusion, endoscopic treatment, or surgery)

to get a score of ZERO:

  • BUN <6.5 mmol/L
  • Hemoglobin >=130 g/L (men) or >=120g/L (women)
  • SBP >=110 mmHg
  • Pulse <100 
  • absence of melena, syncope, cardiac failure, or liver disease

no interventions, no deaths in the ZERO GBS score group

2nd phase of study used the GBS score for 491 patients

  • 123 scored as low-risk
  • 84/123 not admitted
  • only 23/84 offered outpatient endoscopy showed up for it – none needed intervention
  • 1 died from disseminated (non-upper GI) malignant disease (endoscopy only showed gastritis)
  • of the rest, no one got readmitted for GIB or died in 6 mo follow-up

BOTTOM LINE:

upper GIB patients with the following criteria may be considered for discharge and outpatient follow-up:

  • BUN <6.5 mmol/L
  • Hemoglobin >=130 g/L (men) or >=120g/L (women)
  • SBP >=110 mmHg
  • Pulse <100 
  • absence of melena, syncope, cardiac failure (historic or otherwise), or liver disease

References: article; picture

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