Comparison of the AIMS-65 Score with the Glasgow-Blatchford Score in Upper Gastrointestinal Bleed in the Emergency Department

Abstract

Aim: Upper gastrointestinal (UGI) bleed can be a life-threatening condition commonly seen in the emergency department (ED). Hence, to efficiently allot resources, optimize care, and ascertain the disposition of the patient, it is important to determine the severity of UGI bleeding. The objective of the study is to compare patients presenting with UGI bleeding with both the AIMS-65 and GBS to determine most appropriate score in prognosticating clinical outcomes and to identify high-risk patients needing transfusion of blood, endoscopic intervention, and admission to an intensive care unit (ICU) from the ED.Materials and Methods: A prospective, observational study of patients presenting with an UGI bleed from April 2014 to June 2015. All patients above 18 years of age presenting to the ED with hematemesis, melena, or having blood on nasogastric aspirate are enrolled into the study. Patients aged less than 18 years with hemoptysis, hematochezia, or traumatic oral bleeding were excluded. The AIMS-65 and GBS were calculated for all patients and correlated with the duration of their stay in the hospital, mortality, the need for blood transfusion and endoscopy.Results: Of the 138 UGI bleeding patients, 37% had esophageal varices and 23% had peptic ulcer disease. The GBS was better than the AIMS-65 in predicting the need for blood transfusion. Compared with the GBS, the AIMS-65 score was statistically significant in prognosticating mortality in-hospital and the patient’s disposition to the ward or an intensive care unit.Conclusion: The AIMS-65 score is a simple, appropriate, non-endoscopic risk score that can be employed in patients with acute UGI bleeding, aiding in triage, early decision-making, and proper disposition from the ED.

Keywords

• Upper gastrointestinal bleed
• gastrointestinal hemorrhage
• UGI bleed
• Glasgow-Blatchford Score
• AIMS-65
• endoscopic intervention
• ICU Care
• blood transfusion
• disposition from ED
• emergency department