We reviewed and extracted data from the electronic medical records of consecutive adult patients who presented with signs or symptoms of UGIB (hematemesis and/or melena) to an academic ED from April 1, 2004, to April 1, 2009. The primary outcome was need for intervention (blood transfusion and/or endoscopic/surgical intervention) or death within 30 days.
We identified 171 patients with the following characteristics: mean age of 69.9 years (SD, 17.0 years ), 52%women, 20%with a history of liver disease, and 22%with history of gastrointestinal bleeding. Ninety (52.6%, 95%confidence interval, 44.9-60.3) patients had the primary outcome. GBS outperformed pre-endoscopy RS [area under the receiver operating characteristic curve (AUC) = 0.79 vs 0.62; P = .0001; absolute difference, 0.17]. The prognostic accuracy of GBS and post-endoscopy RS was similarly high (AUC, 0.79 vs 0.72; P = .26; absolute difference, 0.07). The specificity of GBS and RS was suboptimal at all potential decision thresholds.
Although GBS outperformed pre-endoscopy RS, the prognostic accuracy of GBS and post-endoscopy RS was similarly high. The specificity of GBS and RS was insufficient to recommend use of either score in clinical practice.