Date of Award
2020
Document Type
Dissertation
Degree Name
Master of Medicine (MMed)
First Supervisor/Advisor
Dr. Casmir Wambura
Second Supervisor/Advisor
Dr Renatus Tarimo
Department
Medical College (East Africa)
Abstract
Background: Acute upper gastrointestinal bleeding (UGIB) remains a common cause of visits to the Emergency Department (ED). To stratify the risk of complications, rebleeding, need for clinical intervention, or death, several clinical scores are in use. Glasgow-Blatchford Score (GBS) is an excellent risk assessment tool and has shown to accurately identify patients with a low risk of death or requiring intervention. In urban Tanzania, there is a lack of standardized protocol and a well-validated risk assessment tool for analyzing patients presenting with UGIB symptoms. Good performance of GBS score and its use will help to reduce unnecessary emergency endoscopies and hospital admission.
Objectives: This study aimed to evaluate the ability of Glasgow Blatchford scores to identify low-risk patients presenting with UGI bleeding and further determine the cut-off value for complications in our population.
Methods: This was a retrospective study on patients who attended the ED with symptoms of UGIB over an 18 month period (June 2018- January 2020). The medical records of all eligible cases presented at Aga Khan and Muhimbili National Hospital were reviewed. Patient profile, clinical characteristics, GBS score, and complication were analyzed. To assess the validity of the GBS at separating low and high-risk groups, receiver-operator characteristic curves were plotted.
Results: A total of 132 patients with UGI bleeding were enrolled in the study. Mean GBS scores were 5.91±4.42. Performance of the GBS system was evaluated in the determination of low risk, for value of GBS >0 the sensitivity and specificity were 100.0% and 31.6% respectively, 100.0% and 58.3% for cut-off value of GBS >1, 97.2% and 71.6% for cut- off value of GBS >2, 86.1% and 80.0% for cut-off value of GBS >4. Our study showed 100% of low-risk patients who had a GBS score of ≤1 did not have any complications that needed intervention. Thus a GBS cut-off value of < 2 is useful for distinguishing patients with a low-risk UGI bleed. The area under the curve (ROC) was found to be 0.911 (95% confidence interval [CI]: 084 – 0.95)
Conclusion: The Glasgow Blatchford Scoring system proved to be a useful scoring system for risk analysis of patients presenting with UGI bleeding in our emergency department.
Recommended Citation
Mpiri, Selestin (2020). Utility of glasgow-blatchford scoring system in identification of low risk patients with upper gastrointestinal bleeding in emergency departments in Dar es salaam hospitals, Tanzania (Unpublished Masters Thesis). Dar es salaam: Aga Khan University