Blatchford score is a useful tool for predicting the need for intervention in cancer patients with upper gastrointestinal bleeding. Ahn S, Lim KS, Lee YS, Lee JL. Asan medical center, University of Ulsan, College of medicine, Cancer Emergency Room, Department of emergency medicine. J Gastroenterol Hepatol Feb 22. Ahn SLim KSLee YSLee JL Marna Bouwhuis

 Upper gastrointestinal bleeding (UGIB) is a common medical emergency in clinical practice, and is a frequent cause of hospital admission.  Accurate risk stratification of patients presenting to the emergency department (ED) with UGIB can assist physicians with the decision to discharge or to admit the patient to inpatient units.  Several risk scoring systems for UGIB:  The clinical Rockall score: clinical variables without endoscopic findings.  The full Rockall score adds endoscopic variables to the clinical variables.  The Blatchford score: history, physical examination, and basic laboratory tests without endoscopic information.  Malignancies are known to account for 1% of severe UGIB.  Some authors suggest that UGIB from cancers should be classified as high risk bleeding.  Presence of malignancy is not considered as a prognostic factor in the Blatchford score. Introduction

BlatchfordClinical RockallFull Rockall Blood ureaAge HemoglobinRR systolic < 100 RR systolicPulse >100 Coexisting illness MelenaEndoscopic diagnosis SyncopeStigmata of recent hemorrhage Hepatic disease Cardiac failure Classifications

 Electronic medical record search of adult patients (>18 years) with active cancer.  January 2009 to December  UGIB was defined as hematemesis, coffee-ground vomiting, or melena.  History, clinical presentation, vital signs, lab results, findings of endoscopy and types of clinical interventions (transfusion, therapeutic endoscopy, angiographic embolization and surgical treatments).  To perform therapeutic endoscopy was at the discretion of the endoscopist, the decision to transfuse blood was determined by the treating physicians.  All patients received endoscopic evaluation within 24 hours.  Source of bleeding was classified into cancer bleedings and non-malignant lesions. Methods

 225 episodes of UGIB in patients with cancer.  Melena most common presenting (75.6%) complaint.  Primary tumor sites were in upper gastrointestinal tract (52.4%), pancreaticobiliary tract (36.0%), liver (6.2%), and others (5.3%). Around 70% of patients had distant metastasis.  Upper gastrointestinal endoscopy was performed in 197 (87.6%).  Cancer bleeding was a source of UGIB in 122 (54.2%) patients, and 103 (45.8%) has non-malignant lesions.  Interventions were done in 197 (87.6%) patients; 190 (84.4%) blood transfusions, 78 (34.7%) endoscopic interventions, 17 (7.6%) angiographic interventions, and 3(1.3%) surgeries.  UGIB recurred in 67 (29.8%) Results

 Blatchford score was better than both clinical and full Rockall scores at predicting the need for intervention in patients with cancer.  Blatchford score was inferior to both Rockall scores for prediction of rebleeding or mortality within 30 days. Conclusions