The Predictive Value of Pre-Endoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients with Upper Gastrointestinal Bleeding – A Systematic Review

Abstract

Objectives

Risk-stratification of emergency department (ED) patients with upper gastrointestinal bleeding (UGIB) using pre-endoscopic risk scores can aid ED physicians in disposition decision-making. We conducted a systematic review to assess the predictive value of pre-endoscopic risk scores for 30-day serious adverse events.

Methods

We searched MEDLINE, PubMed, Embase and the Cochrane Database of Systematic Reviews from inception to March 2015. We included studies involving adult ED UGIB patients evaluating pre-endoscopic risk scores and excluded reviews, case reports and animal studies. The composite outcome included 30-day mortality, recurrent bleeding and need for intervention. In 2 phases (screening and full review), 2 reviewers independently screened articles for inclusion and extracted patient level data and the consensus data was used for analysis. We reported sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratios with 95% confidence intervals.

Results

We identified 3,173 articles, of which 16 were included: 3 studied Glasgow Blatchford Score (GBS), 1 clinical Rockall score (cRockall) and 2 AIMS65; 6 compared GBS and cRockall, 3 compared GBS, a modification of the GBS and cRockall and 1 compared the GBS and AIMS65. Overall, the sensitivity and specificity of the GBS was 0.98 and 0.16 respectively; for the cRockall it was 0.93 and 0.24 respectively; and for the AIMS65 it was 0.79 and 0.61 respectively. The GBS with a cut-off point of 0 had a sensitivity of 0.99 and a specificity of 0.08.

Conclusion

The GBS with a cut-off point of 0 was superior over other cut-off points and risk scores for identifying low-risk patients but had a very low specificity. None of the risk scores identified by our systematic review were robust and hence, cannot be recommended for use in clinical practice. Future prospective studies are needed to develop robust new scores for use in ED patients with UGIB.

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