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Evaluation of the effectiveness of clinical classifications in patients who apply to the emergency department with upper gastrointestinal system bleeding

Objective: The study was planned to determine the suitability of using Rockall and Blatchford scoring systems in emergency departments by evaluating their success in estimating the need for endoscopy and hospitalization along with mortality possibilities in upper GIS bleedings.

Material and Method: Hematemesis, melena, gastrointestinal hemorrhage, hemoptysis, nausea and vomiting, syncope ICD 10 diagnosis codes were entered during the application to the emergency department and 644 patients subject to endoscopy were scanned with 644 patient protocol numbers, 188 patients were included in the study. Rockall and Data about Blatchford scores, patient mortality, hospitalization and discharge were entered into the system. The calculated scores were compared.

Results: The general age average was 65.16 ± 16.61 Rockall score average was calculated as 2.75 ± 1.88, Blatchford score average was calculated as 9.72 ± 3.84. Based on the Rockall scores, 86 (45.7%) of 188 patients were low risk, 102 (54.3%) were high risk; whereas based on the Blatchford scores, 9 (4.8%) of the 188 patients were low risk and 179 (95.2%) were high risk. When the reliabilities of the scores were evaluated, it was determined for the Rockall score that the sensitivity value was 73.9% and the specificity value was 45.6%, whereas sensitivity for the Blatchford score was 96.1%and specificity was 10%.

Conclusion: In conclusion, risk evaluations carried out using laboratory and clinical findings (Rockall, Blatchford) may be used to generate prediction models for defining the hemorrhage risk that is life threatening in patients with upper GIS bleeding. Early and effective evaluation of the patients along with proper medical and support treatment are very important for the prevention of advanced morbidity and mortality that might occur as a result of upper GIS bleeding.

Author(s): Ahmet Kayali, Pinar Yesim Akyol, Fatih Esad Topal, Umut Payza, Firdes Topal, Serkan Bilgin, Zeynep Karakaya