Critical Care: Heme and infection ICU |

Can the Glasgow Blatchford Bleeding Score Be Used as a Criteria for Admission to the ICU in Cases of an Acute Gastrointestinal Bleed? FREE TO VIEW

Scott Lieberman, MD; Ramon Valentin, DO; Luis Lara, MD; Ben Krempley, MS
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Cleveland Clinic Florida, Weston, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):287A. doi:10.1016/j.chest.2016.08.300
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SESSION TITLE: Heme and infection ICU

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 07:30 AM - 08:30 AM

PURPOSE: Gastrointestinal bleeding accounts for more than 300,000 hospital admissions per year. The mortality for such cases is about 5%-12%. Close to 50% of all patients diagnosed with an acute GI Bleed were inappropriately admitted to the Intensive Care Unit. Furthermore, only 19%-28% of all GI bleed patients experience complications that warrant ICU interventions. 20%-30% of all hospital costs are attributed to the ICU. Inappropriate admission to the ICU results in a longer hospital stay, unnecessary cost burden and utilization of scare ICU resources. There is no universal consensus admission criteria for those patients with acute gastrointestinal bleeding that warrant ICU admission as opposed to general medical floor admission. The goal of our study was to determine if the Glasgow Blatchford Score (GBS) could be used as an ICU admission criteria as well as which GBS factors were surrogates for hemodynamic instability.

METHODS: We performed a retrospective chart review of 709 patients diagnosed with acute gastrointestinal bleeding between 2009 and 2013. Of these patients, 475 were upper GI bleeds and the balance were lower GI bleeds (164). We excluded any patients not primarily admitted for an acute GI bleeds. As such, ninety-three patients were excluded for being admitted for other primary medical conditions such as pneumonia, sepsis, etc. Additionally, we excluded all patients that malignancies in their medical history, either current or past (106 patients). After exclusions, our evaluable patients numbered 510. The Glasgow Blatchford Bleeding score was then calculated using admission BUN, Hemoglobin, initial SBP, heart rate, Hx of melena, syncope, history of liver disease or heart failure. We ran regression analysis, ANOVA and correlations for each criterion.

RESULTS: We found that of the patients admitted with an acute GIB, those with GBS of 13 or higher were more likely to require ICU admission, p = 0.01. Furthermore, we found that those patients with a systolic blood pressure of less than 90mm/Hg were found to be more ICU appropriate R2 0.17 and p value < 0.05 and thus provided the biggest predictor within the Glasgow score of patient instability.

CONCLUSIONS: Our study showed that the Glasgow Blatchford score for GI Bleeds can be used as a surrogate ICU admission criterion. Furthermore, it showed that patients with a GBS greater than 13, largely in part due to low admission BP, displayed hemodynamic instability and warranted ICU admission. In the absence of any formal ICU criteria, patients who were admitted to the ICU had a prolonged hospital stay of 6 days as compared to 4 days with those admitted to the general wards. By using the Glasgow Blatchford Score in the Emergency department for each acute GI Bleed, this study provides an objective assessment tool in identifying which patients truly warrant ICU evaluation.

CLINICAL IMPLICATIONS: In the setting of no universal ICU admission criteria for acute GIB, the Glasgow Blatchford Bleeding Score can be used as such criteria. Furthermore, we believe that the factors of the GBS are a surrogate for the stability of a patient being admitted for an acute GIB. Our belief is that if admitting physicians calculate the GBS on admission, accurate placement and appropriate level of care will ensue.

DISCLOSURE: The following authors have nothing to disclose: Scott Lieberman, Ramon Valentin, Luis Lara, Ben Krempley

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