The Blatchford score is an useful index in the management of Mallory-Weiss tear and gastrointestinal bleeding: experience from an urban community hospital.

OBJECTIVES

The purpose of this study was to determine the utility of individual clinical parameters as well as a composite index like the Blatchford score in predicting the need for endoscopic intervention and prognosticating the out come in patients with Mallory Weiss tear presenting with gastrointestinal bleeding.

METHODS

We retrospectively reviewed our endoscopy database and our EMR system to identify patients with Mallory Weiss tear and collect relevant data.

RESULTS

A total of 38 cases with Mallory-Weiss tear were identified at our center over a 5 year period. Thirty-two patients presented with gastrointestinal bleeding constituting 3.1% of all cases presenting with upper gastrointestinal bleeding. Nine (28%) of 32 patients were found to have active bleeding or stigmata of recent bleeding at endoscopy and required endoscopic therapy. The Blatchford score ranged from 0 to 11 in the patients with gastrointestinal bleeding. Nine patients had a Blatchford score < 6 (four 0, five 1-4) while 23 patients had a score > 6. None of the patients with a score < 6 required endoscopic intervention or a blood transfusion while 9 (39%) patients with a score > 6 required endoscopic intervention and 17 (74%) required a blood transfusion. Length of stay was significantly longer in patients with a score > 6.

CONCLUSIONS

The Blatchford score can be a useful index to risk stratify patients with Mallory Weiss tear who present with gastrointestinal bleeding with regards to hospital admission and identifying patients who warrant urgent endoscopic intervention, require blood transfusion and are likely to have a longer length of stay.