Does Your Patient have a Severe Upper GI Bleed (UGIB)?

Author: Michelle Lin, MD
Updated: 6/17/2011

Does Your Patient have a Severe Upper GI Bleed (UGIB)?

JAMA Rational Clinical Examination Series (2012)

Signs

Finding (+) LR (-) LR
Melena on exam 25 (4-174) 0.52 (0.42-0.64)
NG lavage with blood or coffee grounds 9.6 (4-23) 0.58 (.049-0.70)
Clots in stool 0.05 (0.01-0.38) 1.2 (1.1-1.2)

Labs

Finding (+) LR (-) LR
BUN/Cr ratio >30 7.5 (2.8-12) 0.53 (0.28-0.78)

Likelihood of Severe Bleeding Requiring intervention

History

Finding (+) LR (-) LR
Cirrhosis or malignancy hx 3.7 (1.6-8.8) 0.83 (0.72-0.97)
Syncope 3.0 (1.7-5.4) 0.95 (0.91-0.98)
Using analgesics 2.6 (1.3-5.2) 0.92 (0.84-0.99)
Coffee ground emesis 0.41 (0.26-0.64) 1.1 (1.1-1.2)

Signs

Finding (+) LR (-) LR
Pulse >100/min 4.9 (3.2-7.6) 0.34 (0.22-0.53)
NG lavage with red blood 3.1 (1.2-14) 0.32 (0.17-0.57)
NG lavage with red blood or coffee grounds 2.0 (1.0-4.0) 0.40 (0.20-0.81)
Hypotension 1.2-4.8 0.51-0.78

Labs

Finding (+) LR (-) LR
HgB <8 g/dL 4.5-6.2 0.36-0.41
BUN >90 mg/dL 3.6 (2.4-5.5) 0.45 (0.31-0.65)
WBC >12 3.4 (2.2-5.1) 0.48 (0.34-0.68)

Blatchford Score

Validated decision tool to identify UGIB patients who DON'T need urgent intervention

Serum BUN (mg/dL)

Finding Score
<18.2 0
18-22.4 2
22.4-28.0 3
28-70.0 4
≥70.0 6

Hemoglobin (men, g/dL)

Finding Score
>13 0
12-12.9 1
10-11.9 3
<10 6

Hemoglobin (women, d/gL)

Finding Score
>12 0
10 - 11.9 1
<10 6

SBP (mmHg)

Finding Score
>109 0
100-109 1
90-99 2
<90 3

Others

Finding Score
Pulse >100/min 1
Melena on Exam 1
Syncope 2
Hepatic disease 2
Heart failure 2

Likelihood Ratio of Need for Urgent Evaluation by Score

Blatchford Score (+) LR (-) LR
0 1.2 (1.0-1.3) 0.2 (0-0.05)
≤2 1.4 (1.1-1.8) 0.08 (0.01-0.41)

References

  • Kumar R, Mills AM. GI Bleeding. EM Clin N Am. 2011; 29:239-52. [PubMed]
  • Srygley FD et al. Does this patient have a severe UGIB? JAMA. Mar 14, 2012; 307(10):1072-9. [PubMed]