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Comparison of Glasgow Blatchford, pre-endoscopic Rockall, and modified early warning score systems to predict the clinical outcome of patients with upper gastrointestinal bleeding in the emergency

100%

Krishna B. S. G., Goud D. P. K., Velavarthipati R. S., Priya S., Harish K., Praveen K.

Critical Care Innovations

2023

vol. 6

issue 3

37-51

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a life-threatening presentation to the emergency department (ED). In a busy emergency department, emergency department, proper risk stratification is critical to better patients management for patients with variceal or nonvariceal bleeding. This study study was designed to the scoring systems (Modified Early Warning Score (MEW), Pre-endoscopic Rockall (PER), and Glasgow Blatchford Score (GBS) in predicting 15-day mortality, requirement of blood transfusion, probability of rebleeding, and patient outcome within 15-day period in ED. MATERIAL AND METHODS: This study was carried out in with 51 acute UGIB at the emergency department, Department (ED) and department of Medical gastroenterology (MGE) of Narayana Medical College and Hospital, Nellore, India, from February 2020 to June 2022. Clinical The clinical history, presenting signs and symptoms, comorbidities, vitals, laboratory variables, endoscopic diagnosis and treatment history of all patients were recorded and they were followed for 15 days to evaluate rebleeding and its outcome. The chi-square test was applied to qualitative variables. RESULTS: The study enroled 51 patients, of which 82.4% were male, with the majority between 51 and 60 years of age. The majority of cases were presented to the emergency department with haematemesis (60.8%). Non-vasriceal bleeding observed in 94.1% cases. In the 15-day follow- up, 7 patients (7.84%) died and 7 patients (13.7%) rebleed. Totally 26 (50.9%) had a MEWS score of 1, 13 (25.4%) had a score of 2, 9 (17.64%) had a score of >3, and 3 (5.88%) had a score of 0. A PER score of 1 was found in 17 (33.3%), 2 in 4 (7.84%), 3 in 3 (5.88%), 4 in 6 (11.76), 5 in 10 (19.6%) and 6 in 5 (9.80%) patients. 9 (17.6%) cases had a low-risk GBS score of 0-5. Compared to MEWS and GBS, the ROC curve for mortality calculated at 15 days for PERS was 0.96; 95% CI of 0.9 - 1.0, indicating good accuracy. The AUCROC curve for predicting rebleed by PERS score showed area under curve - 0.79, which is also better than the other 2 scoring systems. CONCLUSIONS: PER had a higher negative predictive value (90%) than GBS (80.7%) and MEWS (88.1%) for rebleed measurement. GBS had a higher negative predictive value (96.15%) than PER (52.5%) and MEWS (42.8%) to predict admission of a patient with UGIB. The GBS score >8.5, MEWS score >1.5, and the PER score 4.5 predicted rebleeding. The GBS predicted the need for packed red blood cell transfusions better than the MEWS score and the pre-endoscopic Rockall score. The MEWS score is better at predicting admission and type of bleeding.

To determine the prognostic accuracy of the HEART score as a predictor for major adverse cardiac events in patients presenting with chest pain to emergency department in a tertiary care hospital

100%

Krishna P. P., Velavarthipati R. S., Srikanth M., Krishna B. S. G., Sriramula N., Goud D. P. K.

INTRODUCTION: One of the main causes of sudden cardiac death in the emergency department is myocardial infarction. Although there are several scores that helped predict an identified acute coronary incident, there was no quantitative tool available to risk stratifying patients with chest pain to support more decisions. The study is aimed to determine the prognostic accuracy of the HEART score as a predictor for major adverse cardiac events in patients presenting with chest pain to the emergency medicine department (ED). MATERIAL AND METHODS: Study included 83 adult patients presenting with Acute Myocardial Infarction who had chest pain attending to the ED were studied their HEART score to predict major adverse cardiac events. RESULTS: 60.24% of males and 39.76% of females with mean age of 57.83 ± 12.85 years were presented to ED. 44.56% had hypertension, 46.99% of diabetes mellitus, 21.69% of smoking, 16.87% of alcoholism, 4.82% of obesity, and 3.61% of patients with family history of cardiac diseases. 28.92% had non-specific repolarization, and 33.73% of patients had significant ST-Depression. According to Heart score, 26.51% of patients had low risk, 39.76% of patients had moderate risk, and 33.73% of patients had high risk. More percentage of male patient’s (67.9%) were in the high risk group of heart score than females (32.1%). ST-Depression cases were more in the high risk group (85.7%), and statistical significant association seen between ECG and the heart score (P<0.0001). among risk factors, Hypertension and Diabetes mellitus patients was more in the high risk groups with 48.6%, and 53.8% (P=0.001). 100% of high risk cases had ≥3 x normal limit of troponin, and there was a statistically association seen between troponin and heart score (P<0.0001). Diagnosis of HEART score of the low risk group showed that the risk factor had significantly higher AUC value (AUC = 0.801) than the age group (AUC = 0.778), history (AUC = 0.747), Troponin (AUC = 0.738), and ECG (AUC = 0.722). Out of 22 cases of the low risk group, 6 of Unstable angina (UA), 16 of NSTEMI, 4 of Percutaneous coronary intervention (PCI), 2 CABG, and 1 cardiovascular (CV) death. For moderate risk group (n=33), 13 of UA, 17 of NSTEMI, 3 of STEMI, 20 of PCI, 14 of CABG, and 12 of CV deaths. For high risk group (n=28), 10 UA, 14 of NSTEMI, 3 of STEMI, 9 of PCI, 6 of CABG, and 4 number of CV death. CONCLUSIONS: It was concluded that the HEART score should be used as the primary clinical decision tool for the risk stratification and a good predictor of major adverse cardiac events in patients presenting with chest pain to the emergency department to promote their safe and efficient nature in a community hospital setting.

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2 Critical Care Innovations

2 2023

2 Goud D. P. K.

2 Krishna B. S. G.

2 Velavarthipati R. S.

1 Harish K.

1 Krishna P. P.

1 Praveen K.

1 Priya S.

1 Srikanth M.

1 Sriramula N.

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Comparison of Glasgow Blatchford, pre-endoscopic Rockall, and modified early warning score systems to predict the clinical outcome of patients with upper gastrointestinal bleeding in the emergency

To determine the prognostic accuracy of the HEART score as a predictor for major adverse cardiac events in patients presenting with chest pain to emergency department in a tertiary care hospital