Predicting outcome of upper gastrointestinal bleeding without endoscopy using the clinical Rockall score and Blatchford

Abstract

     Background: The scoring system for upper gastrointestinal bleeding (UGIB) recently use clinical criteria and endoscopic finding to distinguish patient into high and low risk for recurrent bleeding and mortality rate. However, not every hospital in Thailand has endoscopy available. This study aimed to determine sensitivity and specificity of Blatchford score and  clinical Rockall score in classifying patient at risk of recurrent UGIB.      

     Method:  Retrospective study of consecutive patient with UGIB at HRH Princess Maha Chakri Sirindhorn Medical Center  during January 2006 until December 2008. High risk patients was defined as a Blatchford score of greater than 0 or a clinical Rockall score of greater than 0       

     Result:  A total of 215 patients with UGIB were enrolled in this study. Male to female ratio was 132 to 83 with mean age 64.26 years. The Blatchford score identified 157 cases (100%) as high risk patients. The clinical Rockall score identified 146 cases (93%) as high risk patients.           

     Conclusion: Without endoscopic finding, Blatchford score could be used to identify patient with high risk UGIB. It has higher sensitivity than clinical Rockall score. In this study, Blatchford score greater than 5 can use to identified for high risk patient. And if Blatchford score identify as low risk patients, they are able to elective endoscopy.