Validation of High Risk Clinical Scoring: As a Sensitive Method to Predict Endoscopic Severity and Adverse Outcome in patients with UGI Bleed
2007
In our hospital, the Government General Hospital, Chennai, we started
this study with the objectives of identifying high risk clinical features in upper
Gastrointestinal bleeding and testing the sensitivity of high risk clinical features
in predicting endoscopic severity and adverse outcome like Rebleed and
Mortality.
We studied 50 consecutive patients admitted with UGI bleed in Medical
and Surgical wards prospectively. Clinical assessment was done by taking
careful history, bedside examination and basic blood investigation.
We assigned a score for each parameter with due emphasis laid over
quantity of bleed, continued bleed, unstable hemodynamics, altered
consciousness level and presence of co-morbidities.
After clinical stabilisation, all the patients were subjected to early upper
GI endoscopy. And endoscopy revealed those patients with high risk clinical
score, had high grade ulcer bleed in the non - variceal category based on
Forrest classification and high grade esophageal varices, in the variceal
category.
Endoscopy also provided an excellent correlation between high risk
clinical scoring and early adverse outcome like Rebleed and Mortality.
We found that clinical risk scoring was a sensitive tool in identifying
patients who are at higher risk of morbidity and mortality from UGI bleed and
in predicting endoscopic severity.
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