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Fluids & Electrolytes
A few simple tests can help clinicians determine which patients with upper gastrointestinal (GI) bleeding may safely be managed as outpatients. In two studies, researchers evaluated the effectiveness of the Glasgow-Blatchford bleeding score (GBS), which is based on simple clinical and lab variables. A score of zero indicates a low-risk condition that might be managed without hospitalization. For a score of zero, a patient needs to meet these criteria: a heart rate of less than 100 beats/minute, systolic BP of more than 110 mm Hg, hemoglobin of more than 13 grams/dL for men or 12 grams/dL for women, normal blood urea nitrogen, and the absence of melena, syncope, heart failure, or liver disease.
One study was conducted at four hospitals in the United Kingdom. In all, 676 patients with upper GI bleeding were assessed using GBS and an alternative testing method. Under the GBS system, 16% of patients scored a zero. For predicting the need for intervention or death, the GBS was superior to the alternative method.
In two hospitals using the GBS method in clinical practice, 123 patients (22%) with upper GI bleeding were identified as low-risk. Of those, 84 (68%) were managed as outpatients without complications. The percentage of patients with upper GI bleeds who were hospitalized fell from 96% to 71%.
Researchers concluded that GBS identifies many patients with upper GI bleeding who can be safely managed as outpatients, reducing hospital admissions and freeing up scarce hospital resources.
Source: Stanley AJ, Ashley D, Dalton HR, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet. 2009;373(9657):42-47.
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