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Haemtemesis

Dr Swapnil Pawar February 19, 2022 27


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    Haemtemesis
    Dr Swapnil Pawar

Scoring systems in upper GI bleeds

Scoring systems are helpful in identifying patients who are low risk for rebleeding or mortality, and therefore can be considered for outpatient management

Glasgow-Blatchford Score 

Glasgow Blatchford Score does not take endoscopic data into account so it can be calculated when the patient first presents. It is considered to be of low risk when the total score is 0. Any score higher than 0 is indicative of requiring intervention, whether that be transfusion, endoscopy or surgery.

Glasgow-Blatchford Score
BUN (mmol/L)
<6.5 0
6.5-8 +2
8-10 +3
10-25 +4
>25 +6
Haemoglobin (g/L) for men
>130 0
120-130 +1
100-120 +3
<100 +6
Haemoglobin (g/L) for women
>120 0
100-120 +1
<100 +6
Systolic blood pressure (mm Hg)
≥110 0
100–109 +1
90–99 +2
<90 +3
Other criteria
Pulse ≥100 (per min) +1
Melena present +1
Presentation with syncope +2
Liver disease history +2
Cardiac failure present +2

 

Rockall score

The Rockall score was developed to give a percentage risk of rebleeding and total deaths. It .can be used to stratify patients who may need intensive care but is less accurate in identifying low-risk patients that can be managed as an outpatient. 

With a score of 0-1, there is a 0% mortality and at a score of 2, there is a 0.2% mortality risk.

Rockall Score
Age (years)
<60 0
60-79 +1
>80 +2
Haemodynamic Shock (SBP + HR)
NO SHOCK 0
Tachycardia (HR >100 but SBP > 100) +1
Hypotension (SBP <100) +2
Major Co-Morbidities
None 0
Any EXCEPT (1) renal failure (2) liver failure) (3) disseminated malignancy +2
(1) renal failure (2) liver failure) (3) disseminated malignancy +3
Diagnosis (endoscopy)
Mallory Weiss Tear 0
No lesion/no stigmata or recent haemorrhage 0
All other diagnosis +1
Malignancy of upper GI Tract +2
Major stigmata of recent haemorrhage (endoscopy)
Dark spot only  0
Blood in upper GI tract +2
Adherent clot +2
Visible or spurting vessel  +2 

Approach to acute upper gastrointestinal bleeding in adults [updated 2021 October]. In: Therapeutic Guidelines [digital]. Melbourne: Therapeutic Guidelines Limited; 2022 Jan. <https://www.tg.org.au>

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