Escala de Glasgow-Blatchford para la estratificación de riesgo de hemorragia digestiva alta, Hospital Luis Vernaza mayo/2014 - octubre/2015
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2017
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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El objetivo principal de este trabajo fue establecer la utilidad de la escala de GlasgowBlatchford como herramienta para estratificar el riesgo de los pacientes con hemorragia digestiva alta, revelando el puntaje inferior al cual no se registraron muertes y no se requirieron intervenciones, por lo que podrían tratarse ambulatoriamente. Para este propósito, se realizó un análisis retrospectivo de los pacientes mayores de 18 años con sangrado digestivo alto que ingresaron a la emergencia del hospital Luis Vernaza entre mayo de 2014 y octubre de 2015. Se calculó puntaje de Blatchford en cada caso, considerándose además los hallazgos endoscópicos, intervenciones realizadas, complicaciones y evolución final. Se dividió a los individuos en dos grupos: alto riesgo (aquellos que requirieron intervenciones, presentaron complicaciones o fallecieron) y bajo riesgo (quienes no mostraron ningún criterio de alto riesgo). Se incluyeron 197 pacientes (41 sujetos de bajo riesgo y 156 de alto riesgo). El puntaje de Blatchford medio en el grupo de bajo riesgo fue de 8 puntos (rango 1 – 16), y 13 puntos (rango 4 – 20) en el grupo de alto riesgo, existiendo diferencia estadísticamente significativa entre ambos (p=0.0000001). No se encontró diferencia en la edad media (p=0.4), ni en la distribución de géneros (p=0.7). Se calculó una sensibilidad del 100% y una especificidad del 12% para un puntaje de Blatchford de 3, con un VPP de 81% y VPN de 100%. El análisis de ROC para la estimación de alto riesgo reveló un área bajo la curva de 0.91. En conclusión, con una alta sensibilidad y valor predictivo negativo, la escala de Glasgow-Blatchford demostró ser útil para estratificar el riesgo de los pacientes con hemorragia digestiva alta; aunque por su baja especificidad, tiende a sobrestimar la posibilidad de complicaciones. Además se comprobó que es factible manejar ambulatoriamente a los pacientes con puntaje de Blatchford ≤3.
The main objective of this study was to establish the utility of the Glasgow-Blatchford score as a tool to stratify the risk of patients with upper gastrointestinal bleeding, revealing the lower score to which no deaths were recorded and no intervention was required, so they could be treated outpatient. For this purpose, a retrospective analysis of patients older than 18 years with upper gastrointestinal bleeding who were admitted to the Luis Vernaza hospital emergency between May 2014 and October 2015 was performed. A Blatchford score was calculated in each case, considering also the endoscopic findings, interventions performed, complications and final evolution. Individuals were divided into two groups: high risk (those who required interventions, presented complications or died) and low risk (who did not show any high risk criteria). 197 patients (41 low risk and 156 high risk subjects) were included. The mean Blatchford score in the low-risk group was 8 points (range 1-16) and 13 points (range 420) in the high-risk group, with a statistically significant difference between both (p = 0.0000001). No difference was found in mean age (p = 0.4), nor in gender distribution (p = 0.7). A sensitivity of 100% and a specificity of 12% were calculated for a Blatchford score of 3, with a PPV of 81% and VPN of 100%. The ROC analysis for the high-risk estimate revealed an area under the curve of 0.91. In conclusion, with a high sensitivity and negative predictive value, the Glasgow-Blatchford score proved to be useful for stratifying the risk of patients with upper gastrointestinal bleeding; although due to its low specificity, tends to overestimate the possibility of complications. In addition, it was proved that it is feasible to manage patients with a Blatchford score ≤3 on an outpatient basis.
The main objective of this study was to establish the utility of the Glasgow-Blatchford score as a tool to stratify the risk of patients with upper gastrointestinal bleeding, revealing the lower score to which no deaths were recorded and no intervention was required, so they could be treated outpatient. For this purpose, a retrospective analysis of patients older than 18 years with upper gastrointestinal bleeding who were admitted to the Luis Vernaza hospital emergency between May 2014 and October 2015 was performed. A Blatchford score was calculated in each case, considering also the endoscopic findings, interventions performed, complications and final evolution. Individuals were divided into two groups: high risk (those who required interventions, presented complications or died) and low risk (who did not show any high risk criteria). 197 patients (41 low risk and 156 high risk subjects) were included. The mean Blatchford score in the low-risk group was 8 points (range 1-16) and 13 points (range 420) in the high-risk group, with a statistically significant difference between both (p = 0.0000001). No difference was found in mean age (p = 0.4), nor in gender distribution (p = 0.7). A sensitivity of 100% and a specificity of 12% were calculated for a Blatchford score of 3, with a PPV of 81% and VPN of 100%. The ROC analysis for the high-risk estimate revealed an area under the curve of 0.91. In conclusion, with a high sensitivity and negative predictive value, the Glasgow-Blatchford score proved to be useful for stratifying the risk of patients with upper gastrointestinal bleeding; although due to its low specificity, tends to overestimate the possibility of complications. In addition, it was proved that it is feasible to manage patients with a Blatchford score ≤3 on an outpatient basis.
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Escala de Glasgow-Blatchford, Hemorragia gastrointestinal, Hospital Luis Vernaza, Cantón Guayaquil, Ecuador