Effectiveness of Clinical Scoring Systems in Duration of Hospital Stay, Transfusion Need and Prediction of Re-Bleeding in Patients Admitted to the Emergency Department for Upper Gastrointestinal System Bleeding

Year 2022, Volume: 12 Issue: 2, 255 - 262, 30.06.2022

Müge Çardak Hakbilen Hüseyin Cahit Halhallı Tuğçe Köksal Şimşek Hakan Özerol İlknur Tınmaz Onur Karakayalı

https://doi.org/10.31832/smj.1037148

Abstract

Objective: Upper gastrointestinal system (UGIS) bleeding is a life-threatening abdominal emergency. Numerous scoring systems have been developed to identify patients who may develop mortality due to UGIS bleeding. We aimed to determine the effectiveness of the Glasgow Blatchford Score (GBS), Rockall score (RS), and AIMS 65 score in predicting the length of hospital stay, re-bleeding, and transfusion need.
Material and Methods: It was carried out retrospectively by recording the parameters and clinical scoring systems collected from the archive files and epicrisis information of the patients with the pre-diagnosis of UGIS hemorrhage.
Results: Sixty-three (67.7%) of 93 patients were male. Four patients (4.3%) needed intensive care, and in-hospital mortality occurred in 4 (4.3%) patients. Mortality was observed in 7 patients (7.5%), and recurrent UGIS bleeding was observed in six patients (6.5%). A statistically significant difference was found in AIMS 65 and Rockall scores in predicting -intensive care needs (p<0.05). There was no statistically significant difference between clinical scoring systems in predicting in-hospital mortality and re-bleeding the UGIS at 3-month follow-up. A statistically significant difference was observed with the AIMS 65 score in predicting mortality at a 3-month follow-up (p<0.05).
Conclusion: While there was no statistically significant difference between GBS, RS, and AIMS 65 scores in predicting in-hospital mortality and 3-month re-bleeding, RS and AIMS 65 scores can be used to predict ICU need in the emergency department due to UCIS bleeding. The AIMS 65 score can also be used to predict 3-month mortality.

Keywords

Upper gastrointestinal hemorrhage, Rockall score, AIMS 65, Mortality

Acil Servise Üst Gastrointestinal Sistem Kanaması Nedeniyle Başvuran Hastalarda Klinik Skorlama Sistemlerinin Hastanede Kalış Süresi, Transfüzyon İhtiyacı ve Yeniden Kanama Öngörüsünde Etkinliğinin Araştırılması, Retrospektif Gözlemsel Çalışma

Abstract

Amaç: Üst gastrointestinal sistem (ÜGIS) kanamaları hayati tehlike oluşturabilen abdominal acildir. ÜGİS kanamalarına bağlı mortalite gelişebilecek hastaları belirlemek amaçlı çok sayıda skorlama sistemi üretilmiştir. Skorlama sistemlerinden Glasgow Blatchford skoru (GBS), Rockall skoru (RS) ve AİMS 65 skorunun hastanede kalış süresi, yeniden kanama görülmesi ve transfüzyon ihtiyacı öngörülerinde etkinliğinin belirlenmesi amaçlanmıştır.
Gereç ve Yöntemler: Retrospektif olarak ÜGİS hemoraji ön tanısı ile acil servise başvuran ve hastaların arşiv dosyalarından ve epikriz bilgilerinden toplanan parametreler ve klinik skorlama sistemlerinin kayıt edilmesi ile yürütüldü.
Bulgular: Doksan üç hastanın 63’ü (%67,7) erkekti. Dört hastanın (%4,3) yoğun bakım ihtiyacı mevcut olup, 4 hastada (%4,3) hastane içi mortalite gelişti. Üç aylık mortalite takibinde toplam 7 hastada (%7,5) mortalite gözlendi. Altı hastanın da (%6.5) 3 aylık takiplerinde tekrarlayan ÜGİS kanaması görüldü. Yoğun bakım ihtiyacını öngörmede AİMS 65 ve Rockall skorlarında istatistiksel anlamlı fark tespit edildi (p<0.05). Hastane içi mortalite ve 3 aylık takipte yeniden ÜGİS kanamasını öngörmede klinik skorlama sistemleri arasında istatistiksel anlamlı fark yoktu. 3 aylık takipte mortalite öngörmede AİMS 65 skoru ile istatistiksel anlamlı fark görüldü (p<0,05).
Sonuç: GBS, RS ve AİMS 65 skoru arasında hastane içi mortalite, 3 aylık yeniden kanamayı öngörmede istatistiksel olarak anlamlı bir fark yok iken, RS ve AİMS 65 skoru acil serviste ÜGİS kanamalarına bağlı YBÜ ihtiyacı öngörmede kullanılabilir. AİMS 65 skoru 3 aylık mortaliteyi öngörmede de kullanılabilir.

Keywords

üst gastrointesinal kanama, Rockall skoru, AIMS65 skoru, mortalite

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