Attar Alain, Sebbagh Virginie, Vicaut Eric, Le Toumelin Philippe, Bouhnik Yoram
Service de Gastroentérologie-MICI et Assistance Nutritive, Hôpital Beaujon, Clichy, France.
Scand J Gastroenterol. 2012 Sep;47(8-9):1086-93. doi: 10.3109/00365521.2012.703237. Epub 2012 Jul 10.
The Glasgow-Blatchford score (GBS) has been validated to select severe patients with non-variceal upper gastrointestinal hemorrhage (UGIH). The aim was to compare the yield of the triage based on the GBS with an endoscopist' decision to perform an urgent upper gastrointestinal endoscopy (UGIE) in newly admitted patients and inpatients with UGIH in the setting of an endoscopy on-duty service in 13 tertiary care centers.
During a 6-month period, GBS and patient data were collected for all patients with non-variceal UGIH for whom an UGIE was requested in emergency. If patients experienced severe endoscopic lesion, surgery or death, they were categorized as patients who had been at need for urgent UGIE.
The 102 UGIH patients included (mean age 62, men 73%) had a median GBS of 12 (range 0-21), significantly lower for new patients compared with inpatients (11, range 0-21 vs. 14, range 2-21, respectively, p = 0.001). If triage for urgent UGIE had followed the GBS, no more patients would have had an urgent UGIE compared with what endoscopists performed (99/102 (97%) vs. 92/102 (90%), respectively, p = 0.09). Sensitivity for the detection of patients who needed an UGIE was no different with the GBS than endoscopists (98% vs. 98%, respectively, p = 0.10) and both showed insufficient specificity (4% and 19%, respectively).
The GBS does not detect more patients at need for urgent UGIE than on-duty endoscopists. Both methods lead to numerous unjustified UGIEs. A score that would equally help endoscopists in their decision to intervene urgently is still warranted.
格拉斯哥-布拉奇福德评分（GBS）已被证实可用于筛选非静脉曲张性上消化道出血（UGIH）的重症患者。本研究旨在比较在13家三级医疗中心的内镜值班服务中，基于GBS进行分诊与内镜医师决定对新入院患者和UGIH住院患者进行紧急上消化道内镜检查（UGIE）的效果。
在6个月的时间里，收集了所有因非静脉曲张性UGIH而紧急要求进行UGIE的患者的GBS及患者数据。如果患者出现严重内镜病变、手术或死亡，则将其归类为需要紧急UGIE的患者。
纳入的102例UGIH患者（平均年龄62岁，男性占73%）的GBS中位数为12（范围0 - 21），新患者的GBS显著低于住院患者（分别为11，范围0 - 21 vs. 14，范围2 - 21，p = 0.001）。如果按照GBS进行紧急UGIE分诊，与内镜医师实际进行的情况相比，进行紧急UGIE的患者数量不会更多（分别为99/102（97%） vs. 92/102（90%），p = 0.09）。GBS检测需要UGIE患者的敏感性与内镜医师相比无差异（分别为98% vs. 98%，p = 0.10），且两者的特异性均不足（分别为4%和19%）。
GBS检测出需要紧急UGIE的患者并不比值班内镜医师多。两种方法都会导致大量不必要的UGIE检查。仍需要一种能同样帮助内镜医师做出紧急干预决策的评分系统。
