Evaluating Glasgow-Blatchford score for fast-track emergency management of patients with acute upper gastrointestinal bleeding.

BACKGROUND

Acute upper gastrointestinal bleeding (AUGIB) is a common emergency critical illness that requires prompt assessment upon admission to prevent disease deterioration. As a resuscitation mode, the fast track for emergency treatment increases the success rate and improves patient outcomes. However, misuse will consume resources. The Glasgow-Blatchford score (GBS) is considered to predict the clinical intervention needs for AUGIB patients, guiding diagnosis and treatment. Therefore, clinical research is needed to identify the recommended GBS thresholds that support effective use in AUGIB patients.

AIM: To validate the effectiveness of the GBS in establishing a fast track to reduce the time and cost of treatment for patients with AUGIB.

METHODS

A retrospective analysis was performed using the data of 124 cases of AUGIB patients with GBS ≥ 6 treated at the University-Town Hospital of Chongqing Medical University from August 2020 to April 2023. Based on GBS risk stratification, patients were divided into moderate-risk (12 > GBS ≥ 6) and high-risk (GBS ≥ 12) groups. Furthermore, depending on whether a fast track was established after the patients arrived in the emergency department, the patients were categorized into control and fast-track groups. The changes in various indicators, such as length of time in the emergency resuscitation room, door-to-endoscopy time, total blood transfusion volume, hospitalization duration, and hospitalization costs, were compared between the control and fast-track groups under each risk stratification level.

RESULTS

In the comparison of the aforementioned indicators, the moderate-risk fast-track group did not show any significant differences from the control group (P > 0.05). However, in the high-risk fast-track group, the door-to-endoscopy time, total blood transfusion volume, and hospitalization costs were significantly lower than those in the control group (P < 0.05).

CONCLUSION

Establishing a fast track for emergency treatment based on GBS risk stratification has assessment value in reducing door-to-endoscopy time, decreasing total blood transfusion volume, and lowering hospitalization costs in patients with AUGIB. GBS ≥ 12 is recommended as the threshold for implementing the fast track for emergency treatment, and its clinical promotion is advised.