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]