A COMPARISON OF THE GLASGOW-BLATCHFORD SCORE AND PRE - ENDOSCOPİC ROCKALL SCORE SYSTEMS TO PREDICT CLINICAL OUTCOMES IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING

Öz

Objectıve: Acute upper gastrointestinal system bleeding in patients presenting at the Emergency Department is a significant cause of morbidity and mortality. Different scoring systems have been developed for the evaluation in emergency department of patients with gastrointestinal system bleeding. Emergency endoscopy may not be possible in patients presenting to the emergency department with gastrointestinal bleeding . The aim of this study was to compare pre – endoscopic scoring systems (Like the Glasgow Blatchford Score and the pre -endoscopic Rockall scoring systems ) in patients presenting at the emergency department with upper gastrointestinal system bleeding, to determine high-risk patients and examine the efficacy of these systems in predicting 30-day mortality. Method: This prospective study included patients aged >18 years who presented at the Emergency department of XXX Training and Research Hospital between January 2014 and December 2014 Results: The study included a total of 101 cases with a mean age of 65.62 years (range, 19-97 years). Melena was determined in 45 (44.6%) patients, hematochezia in 25 (24.8%), hematemesis in 26 (25.7%), diarrhea and abdominal pain in 7 (6.9%) and syncope in 1 (1.0%). The mean Blatchford score of the patients was 10.56±3.75 (range, 3-19). According to this scoring system, 6 (5.9%) patients were at moderate risk, 18 (17.9%) at high risk, and 77 (76.2%) at very high risk. The mean pre – endoscopic Rockall score was 3.11±2.37 (range, 0-9). According to this scoring system, 49 (48.5%) patients were at low risk, 22 (21.8%) at moderate risk, and 30 (29.7%) at high risk. Of the 49 cases identified as low risk with the pre- endoscopic Rockall classification, 4 were classified as moderate risk, 14 as high risk, and 31 as very high risk using the Blatchford scoring system. Of the 22 cases identified as moderate risk with the pre- endoscopic Rockall classification, 1 was classified as moderate risk, 2 as high risk, and 19 as very high risk using the Blatchford scoring system. Of the 30 cases identified as high risk with the pre – endoscopic Rockall classification, 1 was classified as moderate risk, 2 as high risk, and 27 as very high risk using the Blatchford scoring system. The differences between the two scoring systems were determined to be statistically significant. No statistically significant difference was determined between the mortality rates of cases according to the Blatchford scoring (p>0.05). The difference between the mortality rates of the cases according to the pre – endoscopic Rockall scoring was determined to be statistically significant (p=0.001, p<0.01). The mortality rate of patients at high risk according to the pre – endoscopic Rockall scoring was determined to be higher. The difference between the mortality rates of the cases at high risk according to the pre- endoscopic Rockall scoring was determined to be statistically significant (p=0.001, p<0.01). The risk of mortality was determined to be 6.022-fold greater in cases at high risk according to the pe - endoscopic Rockall scoring. The odds value for pre- endoscopic Rockall scoring was 6.022 (95% CI: 2.148-16.882). Conclusion: The Blatchford and pre- endoscopic Rockall scoring systems were not seen to be consistent with each other and in the prediction of mortality, pre- endoscopic Rockall scoring was determined to be better.

Anahtar Kelimeler

• Emergency Department
• Gastrointestinal bleeding
• pre- endoscopic Rockall scoring system
• Glasgow-Blatchford scoring system

Kaynakça

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