Comparising AİMS65, early rockall and glascow blatckford score in predicting discharge and mortality in emergency department patients with upper gastrointestinal bleeding; a prospective study

Introduction: Upper gastrointestinal system hemorrhages are a common emergency to a value of approximately 10% mortality, length of hospital stay duration, maintenance costs. Due to high mortality, early endoscopy, early surgical or radiological procedures, intensive care management and treatment metods are essential to decide In this study, our aim is recognise and also comparising GBS, early Rockall and Aims 65 and determine to decision of discharge or hospitalization, erythrocytes transfusion requirement, rebleeding and mortality in emergency department patients. Metods: In prospective observational study 181 cases were evaluated between August 2016 to January 2017 in Ege University School of Medicine Emergency Department. All scores were calculated separately for each patient. When comparing scoring systems the primary and secondary outcome determine with receiver operating characteristic (ROC) for each score. A new cut-off value identified for each scores with a maximum sensitivity and specifity in mortalitity, re-bleeding, eritrosyte requirement and hospitilization. Data was grouped and comparison of categorical variable was tested with pearson's Chi-square. Results: In this study, 40 patients was treated in hospital, 97 patients was need erythrocyte transfusion. A month mortality was determined in 30 patients, 29 had seen re-bleeding within a month. Determining high risk patient the GBS score system (AUC: 0,824) ERS (AUC: 0.691) proved to be superior AİMS65 (AUC: 0,612) (p ≤ 0.05). The success of ERS in the predict of mortality (0,725 ± 0.46) proved to be more successful with the AUC value. ERS's cut-off value of 2 for the sensitive 48.3 and % 83.3 specific.In AIMS 65 scores (0,687 ± 0.58) cut-off value was received 1of sensitive was 60%, spesifity was74.8%. GBS score for predicting mortality of at least proved to be successful. (AUC: 0,628 ± 0.52). Cut-off value of 11 sensitivity % 86.7% and specificity rate %40.4 was shown. Predicting the re-bleeding all the results were statistically significant. (p≤ 0.05) but the AUC value very close to each other, although most successful AUC score: 0,699 ± 0.48 with ERS '. In ERS' cut-off value 3 sensitivity %72.4 and specificity %64.5 was determined. AİMS65 scores cut-off value was received 1 sensitivity 58.6% of 74.6% specificity were calculated. GBS score was received 11 cut-off sensitivity was 89.7% and specificity was 22,4 %. Predicting needs of erythrocyte transfusion GBS (AUC: 0,833 ± 0,30) was the most successful score system. GBS's cutoff value was received 11 sensitivity was % 54.4 and specifity was % 39.2 (p≤ 0.05). Disscusion: In this study, the need for high risk patients, need of erythrocyte transfusions and for predicting the hospitalization, most successful score was GBS. Predicting the re-bleeding within 30 days all score was successful but there was no significant difference between them. Unlike the literature ERS predicted mortality best but had no serious superiority according to AİMS65 scoring. GBS wasn't successful predicts mortality. Risk scores in generally had no good cutoff values, individually the outcome some of cut-off values had high sensitivity, low specificity and high negative predictive value was determined. It is more useful to use these cutoff values for mortality than risk assessment.